In this article, we will discuss the history of the mad doctors and their important role in establishing the insanity defense as we know it today. Emerging in the late 18th century, the mad doctors transformed the general understanding of mental illness and its role during criminal trials.
The History of the Mad Doctors
The mad doctors were the first professionals in the field of psychiatry that began emerging during the late 18th and early 19th centuries. In Victorian England, there was a rapid and growing response to madness firstly with private and for-profit madhouses and then later with the direct involvement of the state to form a network of county asylums for the insane. This development meant that there would be a group of experts in charge of managing the mad.
Additionally, during the 19th century, psychiatry and institutional psychiatry were coextensive in terms of their purpose and intent. The mad doctors are largely responsible for the process of transforming madness into mental illness as we know it today. They served as some of the superintendents of the early asylum for the criminally insane such as Bethlem and Broadmoor.
In 1841, the first professional organization named the Association of Medical Officers of Asylums and Hospitals for the Insane was founded. However, the organization’s effectiveness was quickly diminished, as they were unable to unify the profession between private and public asylums. (Scull, 1976).
What Role Did the Mad Doctor Play in Criminal Cases?
The first known case in which a doctor testified in an insanity case was in 1760, when a physician from Bethlem by the name of John Monro rose to prominence during the famous case of Laurence Shirley, who killed his servant. Monro was there to explain whether or not Shirley was sane at the time of murder. Even though Monro and Shirley had never met, Monro was asked to discuss and explain the symptoms of lunacy and insanity.
The development of the insanity defense in the 19th century was founded primarily on three landmark cases:
In 1800, James Hadfield tried to kill King George III and was sent to an asylum.
In 1840, Edward Oxford tried to kill Queen Victoria and was also confined.
In 1843, Daniel M’Naghten (sometimes spelled McNaughtan or McNaughton) killed the secretary of the Prime Minister in an attempt to kill the Prime Minister.
The last case led to the formulation of the M’Naghten Rules, which forever changed the perception of insanity and its influence in trials and the court room (Shepherd, 2017).
The M’Naghten Rules
In 1843, a man named Daniel M’Naghten shot the secretary of the Prime Minister, Edward Drummond, in an attempt to assassinate the Prime Minister of England. After a long trial, M’Naghten was deemed “insane.” It was concluded that he suffered “partial insanity or monomania” (insanity focused on one area of perception of action) which deprived him of all self-control while the other faculties remained sound. During the trial, he claimed that the “Tories” were after him and were trying to kill him.
The outcome of the trial sparked massive outrage among the public, but it also redefined the term “insanity” and fundamentally changed the legal system in terms of dealing with the criminally insane.
Here are the basic principles of the M’Naghten Rules:
● There is a presumption that every man is sane and that they are responsible for their criminal acts until proven differently
● To be found insane, it must be clearly proven that (due to a defect of reason from disease of the mind) the defendant did not know the nature or quality of what they were doing. If the defendant did know the nature of their crime, they must not know what they did was wrong (“United Kingdom House of Lords Decisions,” 1843).
The M’Naghten Rules were adopted into the US legal system in 1851, though there was criticism, especially in regard to sentencing, medical irrelevance, inability to distinguish between those who posed a danger to the public and those who did not, and inadequate testimony (Garafolo, n.d.).
The Windham Case and Victorian Anti-Psychiatry
One of the most famous cases that saw England’s foremost experts in psychiatry debate the concept of insanity was the case of William Windham. The trial took place in 1861 and 1862 when the wealthy man was accused of lunacy. The case drew a lot of attention due to the public debate between psychiatrists on their respective thoughts about symptoms and the overall diagnosis of insanity. The public, press, and the Parliament had very heated reactions due to the fact that each of the psychiatrists had a very different assessment of Windham’s mental state.
People grew more and more suspicious about the circumstances that led to someone being deemed insane. They even claimed that psychiatrists were coming up with new forms of insanity, such as kleptomania, to help the rich avoid punishment in court. This further led to extensive political resistance towards psychiatry in general in the 1860s, a sentiment often referred to as “Victorian anti-psychiatry” (Degerman, 2019).
The Victorian Age saw the very important transformation of madhouses into asylums and then further into mental hospitals. It also saw the impactful growth of then called mad doctors (later called alienists) into psychiatrists and the progression of madmen and madwomen into patients.
The 18th and 19th century era in England was and continues to be an important stepping stone for today’s psychiatry and criminal defense because it helped bring about institutional treatment and commitment laws, and further refined and articulated the boundary between criminal responsibility and insanity.
Degerman, D. (2019). ‘Am I mad?’: the Windham case and Victorian resistance to psychiatry. History of Psychiatry, 30(4), 457–468. https://doi.org/10.1177/0957154x19867059
Garafolo, A. (n.d.). The McNaughton Rules | History of Forensic Psychology. History of Forensic Psychology. Retrieved April 5, 2022, from https://historyforensicpsych.umwblogs.org/the-insanity-defense-outline-by-andrew-garofolo/the-mcnaughton-rules/
Scull, A. T. (1976). Mad-doctors and Magistrates: English psychiatry’s struggle for professional autonomy in the nineteenth century. European Journal of Sociology, 17(2), 279–305. https://doi.org/10.1017/s0003975600007384
Shepherd, J. (2017). Joel Peter Eigen, Mad-Doctors in the Dock. Defending the Diagnosis, 1760–1913. Social History of Medicine, 31(1), 179–181. https://doi.org/10.1093/shm/hkx071
“United Kingdom House of Lords Decisions.” (1843) M’Naghten’s Case. UKHL J16 (19 June 1843). JISC, n.d. Retrieved from http://www.bailii.org/uk/cases/UKHL/1843/J16.html
Nina M Benjamin Silber