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Today We will be discussing on Forensic Psychiatry where we will be learning about Mental illness and their criminal aspects.

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Psychiatry deals with the study, diagnosis, and treatment of mental illness.Mental illness or unsoundness of mind can be defined as a disease of the mind or the personality, in which there is derangement of the mental or emotional processes and impairment of behavioral control (in simple language:-INSANITY).

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Forensic Psychiatry deals with the application of psychiatry in the administration of justice.It is involved to determine responsibility for the crime, sexual psychopathy(rape) and other sexual problems, such as homosexuality, transvestism, pedophilia, fetishism(the terms had been explained in my previous post of Sexual perversion), competence in contrast actions, competency to stand and testify, ability to give informed consent, competence to stand the trial, malingering etc.

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Role of Forensic Psychiatrist in Litigations involving questionable mental soundness of a person

The functions of Forensic Psychiatrists in such cases are variant in nature.He/She has to certify mental capacity and soundness of a person in the following circumstances.

A. In relation to criminal cases

• When a defense is attempted on the ground that an act which is otherwise considered as a crime, has been committed by a person in a state of mental unsoundness.
• When an accused on the ground of insanity, expresses his inability to plead his defense during the trial.
• When after being convicted in a court of law, the petition is filed before the court, to defer the execution of the punishment till the convict is mentally sound or, to send him to a mental asylum for treatment, instead of sending him to the prison to serve the term of imprisonment.
• When it is claimed that a person has committed suicide due to the effect of mental unsoundness.
• In connection with a criminal breach of trust or fraud committed against an insane relating business or property matter.
• When an insane woman is raped.

B. In relation to civil cases

• Continuation or dissolution of business contract on the ground of mental abnormality of either partner
• In connection with nullity of marriage or divorce cases.
• Testamentary capacity or capacity to make a valid will.
• Regarding capacity or validity to act or competence as a witness.
• Regarding validity of consent given by an insane person.
• In certain contingencies, like the appointment of a curator or caretaker of a mentally unsound person who is unable to look after his property.

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Common terms used in Psychiatry

Delirium

It is a disturbance of consciousness in which orientation is impaired, the critical faculty is blunted or lost and thought content is irrelevant or inconsistent.
It usually occurs in physical disease, in which there is continuous high temperature, and sometimes due to overwork, mental stress or drug intoxication.A person may become impulsive and violent and may commit suicide.Such person is not responsible for his criminal acts.

Delusion

A false, unshakable belief which is not amenable to reasoning, and is not in keeping with the patient’s socio-cultural and educational background.
A normal person can have a delusion, but he/ she is capable of correcting it by his reasoning power, by his past experience and by being convinced by others.But delusion in insane person is a symptom of brain disease.It is under the control of emotional but not rational forces.
It is of two types:-

Primary Delusion

It arises de novo and cannot be explained on basis of other experiences or perceptions.

Secondary delusion

This is commonest type of delusion seen in clinical practice.This can be explained as arising from other abnormal experiences.
It includes
a. Delusion of persecution(being persecuted against, e.g. 'people are against me’).
b. Delusion of refrence( being referred to by others, e.g. 'people are talking about me’).
c. Delusion of grandeur(exaggerated self-importance, e.g 'I an God almighty’).
d. Delusion of control(being controlled by an external force, known or unknown; e.g. 'My neighbour is controlling me’).
e. Delusion of infidelity(a man imagine his wife to be unfaithful while in fact she is chaste and vice versa).
f. Delusion of nihilism(person declares that he does not exist or that there is no world).
g. Somatic delusion(person believe that there are insects crawling in their scalp and body).
h. Erotomania(person believes that someone is deeply in love with him/ her).

Hallucination

These are perceptions that occur in the absence of a stimulus.They are purely imaginary, and may affect any or all the special senses.

Types

1. Visual
A person sees cat drinking milk kept in the pot when there is none.
2.Auditory
A person hears voices and imagines that a person is speaking to him when no one is present.
3.Olfactory
A person smells pleasant or unpleasant odor when none is present.
4.Gustatory
A person experiences different tastes(sweet, sour, bitter, salt) good or bad taste in mouth in the absence of the particular taste.
5.Tactile
A person perceives crawling of insects over his body when there are none.
6.Psychomotor
Feeling of movement of part of the body(limb) though none occurs to him in reality.
7.Microptic or Lilliputian/Macroptic
A person sees any objects either very small or very large compared to that of their original texture.

Illusion

A misinterpretation of stimuli arising from external objects, e.g., when a person sees a dog and mistake it for lion, or a string hanging in his room to be a snake.
A sane person may experience the illusion but is capable of correcting the false impressions.But an insane person continues to believe in the illusions, even though the real fact is clearly pointed out.

Obsession

In this, a single idea, thought, or emotion is constantly entertained by a person which he/she recognizes as irrational, but persists in spite of all efforts to drive it from his mind.Any attempt to resist makes them appear more insistent and yielding is the almost inevitable outcome.
E.g. A person goes to bed after bolting the door and soon gets up to verify it.A sane person stops after verifying a few times, while an insane person continues the act all throughout the night without sleeping.

Impulse

This is sudden and irresistible force compelling a person to the conscious performance of some action without motive or forethought.

• Kleptomania
  An irresistible desire to steal articles of little value.
• Pyromania
  An irresistible desire to set fire to things.
• Mutilomania
  An irresistible desire to mutilate animals.
• Dipsomania
  An irresistible desire for alcoholic drinks at a periodic interval.

Hysteria

It is characterized by self- dramatization, excessive emotionality and attention seeking behavior.Egocentric and demanding interpersonal relationships are typical of this condition.

Lucid interval

It is a period in insanity during which all the signs and symptoms of insanity disappear and behavior is like that of a normal person.
It is mainly seen in Head injuries.

Psychoses

It is characterized by a marked disturbance in personality, with impairment in social, interpersonal and occupational functioning.There is a gross impairment in reality- testing i.e.'not in contact with reality'.
It is associated with delusion and hallucinations.

Neuroses

The patient suffers from emotional or intellectual disorders, but he does not lose touch with reality.
They occur mostly in the form of anxiety, depression or hysteria.

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These were some of the information regarding Forensic Psychiatry which I wanted to discuss today.Hope you enjoyed reading it.
"Show me a sane man and I will cure him for you."

By C.G. Jung

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References:-

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525122/
2.https://en.m.wikipedia.org/wiki/Forensic_psychiatry
3.The essential of Forensic Medicine and Toxicology 33rd edition by Dr. K.S.Narayan Reddy
4.Principles of Forensic Medicine including Toxicology by Apurba Nandy
5.https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/psychiatry/forensic-psychiatry
6.https://en.m.wikibooks.org/wiki/Textbook_of_Psychiatry/Forensic_Psychiatry

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