Psychiatric commitment under the criminal law in China: An empirical perspective

This article examines the legislation and practice of compulsory treatment in China. Part I traces the Chinese history of criminal commitment law, explains the research methodology, and highlights some general empirical findings. Part II provides a comprehensive empirical analysis of compulsory treatment law in China, it covers both substantial issues such as criteria of compulsory treatment and procedural issues such as the commitment hearing, enforcement, and discharge of compulsory treatment. It also explores the compulsory treatment law from the human rights protection perspective. Our primary objective is to present the empirical findings to enable the legislative and other involved government agencies to make informed decisions about the future evolution of Chinese law in this area.

The professionalization of psychologists as court personnel: Consequences of the first institutional commitment law for the "feebleminded"

The first law providing for the permanent, involuntary institutionalization of "feeble-minded" individuals was passed in Illinois in 1915. This bill represented the first eugenic commitment law in the United States. Focusing on the consequences of this 1915 commitment law within the context of intelligence testing, eugenics, and the progressive movement, this paper will argue that the then newly devised Binet-Simon intelligence test facilitated the definition and classification of feeble-mindedness that validated feeble-mindedness theory, enabled the state to legitimize the eugenic diagnosis and institutionalization of feeble-minded individuals, and especially empowered psychologists to carve out a niche for themselves in the courtroom as "experts" when testifying as to the feeble-mindedness of individuals.

Through a glass darkly: patients of the Illinois State Hospital for the Insane at Jacksonville, USA (1854-80)

The State Hospital for the Insane at Jacksonville, Morgan County, Illinois, was the first public hospital of its kind to be established in the state and among the earliest to be built on the 'Kirkbride Plan'. It opened for patients in 1851. We describe the background to the establishment of the hospital and, so far as is possible from publicly available sources, its catchment area, the nature of the patients held there up to 1880, its mechanisms of discharge, and supposed causes of death. We end with a plea that after over 150 years, the release of hospital casebooks and similar records in digital form would be of considerable benefit to historians of psychology, scientific biographers, genealogists and demographers.

'Insane criminals' and the 'criminally insane': criminal asylums in Norway, 1895-1940

This article looks into the establishment and development of two criminal asylums in Norway. Influenced by international psychiatry and a European reorientation of penal law, the country chose to institutionalize insane criminals and criminally insane in separate asylums. Norway's first criminal asylum was opened in 1895, and a second in 1923, both in Trondheim. Both asylums quickly filled up with patients who often stayed for many years, and some for their entire lives. The official aim of these asylums was to confine and treat dangerous and disruptive lunatics. Goffman postulates that total institutions typically fall short of their official aims. This study examines records of the patients who were admitted to the two Trondheim asylums, in order to see if the official aims were achieved.

Madness and crime: Zefinha, the longest confined woman in Brazil

Living in a forensic hospital for the last 38 years, Josefa da Silva is the longest female inhabitant surviving the penal and psychiatric regime in Brazil. This paper analyses dossier, judicial proceedings, interviews and photographs about her. The psychiatric report is the key component of the medical and penal doubling of criminal insanity. Twelve psychiatric reports illustrate three time frames of the court files: abnormality, danger, and abandonment. The psychiatric authority over confinement has moved from discipline to security, and from disciplinary security to social assistance. In the arrangement between the penal and psychiatric powers, the judge recognizes the medical authority over the truth of insanity. It is the medicine of the reasons for Zefinha's internment that altered over the decades.

The Moral Career of 'Outmates': Towards a History of Manufactured Mental Disorders in Post-Socialist China

This study focuses on 'manufactured mentally ill' (bei jingshenbing, [symbol in text]) individuals in post-socialist China. In Chinese society, bei jingshenbing is a neologistic catchphrase that refers to someone who has been misidentified as exhibiting symptoms of mental illness and has been admitted to a mental hospital. Specifically, it refers to those individuals who were subjected to unnecessary psychiatric treatment during the first decade of the twenty-first century. Based on archival analysis and ethnographic fieldwork, this study addresses the ways in which the voices of bei jingshenbing victims and those who support them reveal China's experiences with psychiatric modernity. It also discusses the active role of these individuals in knowledge production, medical policymaking, and the implications for reforming the psychiatric and mental health systems in post-socialist China.

Clara Harrison Town and the origins of the first institutional commitment law for the "feebleminded": psychologists as expert diagnosticians

The first law providing for the commitment of "feeble-minded" individuals in the United States was passed in 1915, in the state of Illinois. House Bill 655 not only allowed for the permanent, involuntary institutionalization of feeble-minded individuals, but it shifted the commitment and discharge authority from the institution superintendents to the courts. Clara Harrison Town, a student of Lightner Witmer, and the state psychologist at the second largest institution for feeble-minded individuals in the country, was instrumental in this law passing and in ensuring that psychologists, for the first time, be viewed as court "experts" when testifying as to the feeble mindedness of individuals.

Forensic psychiatry and the birth of the criminal insane asylum in modern Italy

This paper focuses on the creation of the criminal insane asylum in Italy between unification in 1861 and World War I. The establishment of criminal insane asylums was a triumph of the positivist criminology of Cesare Lombroso, who advocated for an institution to intern insane criminals in his classic work, Criminal Man (1876). As a context for the analysis of the birth of the criminal insane asylum in Italy, this essay also outlines the history of the insanity plea in Italian criminal law and the young discipline of psychiatry during the fifty years after Italian unification.

Psychiatrists, criminals, and the law: forensic psychiatry in Switzerland 1850-1950

Between 1880 and 1950, Swiss psychiatrists established themselves as experts in criminal courts. In this period, the judicial authorities required psychiatric testimonies in a rising number of cases. As a result, more offenders than ever before were declared mentally deficient and, eventually, sent to psychiatric asylums. Psychiatrists also enhanced their authority as experts at the political level. From the very beginning, they got involved in the preparatory works for a nationwide criminal code. In this article, I argue that these trends toward medicalization of crime were due to incremental processes, rather than spectacular institutional changes. In fact, Swiss psychiatrists gained recognition as experts due to their daily interactions with judges, public prosecutors, and legal counsels. At the same time, the spread of medical expertise had serious repercussions on psychiatric institutions. From 1942 onwards, asylums had to deal with a growing number of "criminal psychopaths," which affected ward discipline and put psychiatry's therapeutic efficiency into question. The defensive way in which Swiss psychiatrists reacted to this predicament was crucial to the further development of forensic psychiatry. For the most part, it accounts for the subdiscipline's remarkable lack of specialization until the 1990s.

Psychiatric care or social defense? The origins of a controversy over the responsibility of the mentally ill in French forensic psychiatry

While some countries like Belgium chose a penal system clearly inspired by social-defense theories for mentally disturbed criminals, the French law hasn't been consistent and varies from the enlightened classical law and social-defense law. Indeed paragraph 1 of article 122-1 states that people whose discernment or control is abolished by a psychiatric disorder are non-responsible respecting the classical logic of law. On the other hand, Paragraph 2 of Article 122-1 allows the mentally ill to be judged responsible whereas no institution exists to take care about them. Then the system of psychiatric care in prisons present as a solution for professionals wishing to promote a system where people are punished and socially rehabilitated. Thus these forensic psychiatrists don't refer to paragraph 1 of article 122-1 and even people presenting serious mental disorders are considered responsible. Moreover, if a controversy has always existed between psychiatrists who argue a large conception of mental irresponsibility and professionals who defend the right to punish and to conclude that responsibility even for mentally disturbed criminals, the controversy becomes more important in French forensic psychiatry after the Second World War. If until the 1970s the practice of imposing responsibility for mentally ill individuals shows itself as a humanism, it occurs more within a security perspective today.

Forensic psychiatric units in Italy from the 1960s to the present

This article addresses the long-standing continuities in the history of the Italian forensic psychiatric units and views them as the result of conflicting forces, interests, mentalities and strategies at the cross-road of forensic psychiatry, psychiatry, prison and health services. It focuses on the period from the 1960s to the present and deals with, among other issues, the long-term impact of the anti-asylum movements and the on-going debate on the 'phasing out' of the forensic psychiatric units.

Mental disorder and criminality in Canada

This article examines the relationship between mental disorder and criminality in Canada from the colonial period to the landmark 1992 Mental Disorder Amendments that followed the passing of Bill C-30. The history of this relationship has been shaped by longstanding formal and informal systems of social regulation, by the contests of federal-provincial jurisdiction, by changing trends in the legal and psychiatric professions, and by amendments to the federal Criminal Code. A study of these longer-term features demonstrates that there has been no linear path of progress in Canada's response to mentally unwell offenders. Those caught in the web of crime and mental disorder have been cast and recast over the past 150 years by the changing dynamics of criminal law, psychiatry, and politics. A long historical perspective suggests how earlier and more contemporary struggles over mental disorder and criminality are connected, how these struggles are bound by historical circumstance, and how a few relatively progressive historical moments emerging from these struggles might be recovered, and theorized to advantage.

Treatment as punishment: forensic psychiatry in The Netherlands (1870-2005)

This article provides an overview of the development of forensic psychiatry in the Netherlands from the late nineteenth to the early twenty-first century. The first part addresses the ways forensic psychiatry established itself in the period 1870-1925 and focuses on its interrelatedness with forensic practice, psychiatry's professionalization, the role of the government, the influence of the so-called New Direction in legal thinking and (Italian and French) anthropology of crime, and the debates among physicians as well as between psychiatrists and legal experts on the proper approach of mentally disturbed offenders. From the mid-1920s on the so-called 'psychopaths laws' anchored forensic psychiatry in the Dutch legal system. The second part zooms in on the enactment of these laws, which formalized special measures for mentally disturbed delinquents. These implied a combination of sentencing and forced admission to and treatment in a mental institution or some other form of psychiatric surveillance. The article deals with the meaning, reach and consequences of this legislation, its debate by psychiatrists and legal experts, the number of delinquents affected, the offenses for which they were sentenced and the (therapeutic) regime in forensic institutions. The goal of the Dutch legislation on psychopaths was ambiguous: if it was designed to protect society against assumed dangerous criminals, at the same time they were supposed to receive psychiatric treatment to enable their return to regular social life again. These legal and medical objectives were at odds with each other and as a result discussions about collective versus individual interests as well as about the usefulness and the effects of this legislation kept flaring up. To this day the history of this legislation is characterized by the intrinsic tension between punishment and security on the one hand and treatment and re-socialization on the other. Whether at some point one or the other prevailed was largely tied to the social climate with respect to law, order and authority.

Topographies of forensic practice in Imperial Germany

This article examines the topography and "cultural machinery" of forensic jurisdictions in Imperial Germany. It locates the sites at which boundary disputes between psychiatric and legal professionals arose and explores the strategies and practices that governed the division of expert labor between them. It argues that the over-determined paradigms of 'medicalization' and 'biologization' have lost much of their explanatory force and that historians need to refocus their attention on the institutional and administrative configuration of forensic practices in Germany. After first sketching the statutory context of those practices, the article explores how contentious jurisdictional negotiations pitted various administrative, financial, public security, and scientific interests against one another. The article also assesses the contested status of psychiatric expertise in the courtroom, as well as post-graduate forensic psychiatric training courses and joint professional organizations, which drew the two professional communities closer together and mediated their jurisdictional disputes.

Insanity, gender and empire: women living a 'loose kind of life' on the colonial institutional margins, 1870-1910

This article examines how female immigrants were characterised inside the Yarra Bend Asylum in Melbourne, Victoria (Hospital for the Insane after 1905), once they slipped into the world of the institutionally 'hidden.' Forms of social difference inside colonial institutions for the insane were embedded in patient case records. This article argues that through a closer examination of cases of female immigrants, we might find out more about gender relations in colonial situations. In particular this article returns to ideas about women patients and constructions of these women through case records to uncover new interpretations of this material in the Australasian context. To do this, it sets out specific ways of reading patient cases and teases out the importance of these frameworks for making some kind of synthesis of the ways in which institutionalised people--already at the margins of society--were further marginalised inside institutional populations through specific practices. It examines immigrant women in the hospitals for the insane; the cases of women designated as living so-called 'loose' lives who also ended up inside the institution for the insane; and finally concludes with a commentary about the descriptive power of cases and the production of concepts of gender, class, and race difference within their pages.

Alexandre Brierre de Boismont and the origins of the Spanish psychiatric profession

This article examines the influence of the French alienist Alexandre Brierre de Boismont in the first development of the Spanish psychiatric profession during the third quarter of the 19th century. As an outstanding figure of French psychological medicine, Brierre enjoyed great scientific prestige among Spanish doctors, but he also took an active part in promoting and legitimizing the cause of alienism in Spain. For instance, he was involved in projects for the reform or creation of new mental hospitals, supported the admission of some Spanish colleagues into the Société Médico-Psychologique and made a decisive contribution to the social recognition of the professional and medico-legal expertise of alienists in Spain. His case is thus an excellent example of the important role played by international relations and the scientific and professional networks of European alienism in spreading the discourses and practices of the emerging psychological medicine.

Insanity and ethnicity in New Zealand: Māori encounters with the Auckland Mental Hospital, 1860-1900

This article examines Māori patients at the Auckland Mental Hospital between 1860 and 1900.We argue that the patient case notes reveal 'European' categories in which Māori were situated, and demonstrate the extent to which the authorities at the hospital grappled with their appearance, their language and their culture, all of which were elements of their ethnicity. We argue that the use of institutional case records is highly suggestive of some of the historical meanings of insanity for Māori, including the lack of detailed or sustained collection of information about patients' tribal affiliations, the interest shown in their rights to land in maintenance payment inquiries, the experiences of cultural alienation or mate Māori, and the sad outcomes for Māori.

[Does the amendment of the rules of Criminal Code referring to mandatory treatment mean paradigm change in the judgement of mentally ill criminals?]

Talking of the Act LXXX. of 2009, the amendment of the Act IV. of 1978 on Criminal Code, the author reviews the Hungarian history of the changes of regulations referring to mentally ill criminals. He discusses the treatment regulations referring to criminals identified as insane, too. From historical and legal philosophical points of view, those parts of the modification of Criminal Code are analyzed that deal with mandatory treatment and took effect in he May 2010. The changes are judged as paradigm changing in a negative course that represents a doubtful step from the direction of perpetrator based criminal law to criminal act based criminal law.

The role of the Irish Division of the Royal Medico-Psychological Association in the development of intellectual disability nursing in Ireland

The development of a specialist intellectual disability workforce in independent Ireland by the Royal Medico-Psychological Association was influenced by nursing regulatory bodies and Catholic religious orders, the latter of which provided lay residential education to people with intellectual disabilities. Although the RMPA shaped curriculum and examinations, practice scope, clinical assessment and practical skills were weighted more heavily towards bedside nursing, psychology and education due to the input of the religious orders and nursing board.

Hell in the family: married women and madness before institutionalization at the St-Jean-de-Dieu Asylum, 1890-1921

Research in Montreal's St-Jean-de-Dieu Asylum archives has revealed a number of letters from family members and local physicians pleading for asylum care for married women between 1890 and 1921. When added to other admission documents in patients' medical files, these letters allow an intimate glimpse into private lives of families and highlight the pain and distress of dealing with mentally ill people in the home before the introduction of community mental health services. Far from easily abandoning a spouse or mother, close-knit French Canadian families struggled until they could no longer cope before seeking help. To comply with asylum regulations, family members (primarily husbands, who were often illiterate) and local physicians were required to justify their applications for admission, but they did so in different ways.

Guardianship appointment: current status in Israel

The appointment of a guardian is an important complex process that significantly infringes upon the individuals liberty and autonomy; however it is a necessary paternalistic intervention when called for. The law does not provide precise criteria for the appointment of a guardian, though physicians have tried to determine criteria for the initiation of the process. The authors present a review of the various aspects of the assessment of the need for guardianship and the appointment process for guardians for adults in Israel. The medical document that will ultimately determine the need for the appointment of a guardian for an elderly person should be the product of a comprehensive medical, psychiatric and cognitive evaluation and an accurate evaluation of competence.

Commentary: civil commitment statutes--40 years of circumvention

There is a longstanding body of literature that describes how states' civil commitment statutes have been stretched or circumvented to accommodate institutional and systemic needs. The paper by Levitt and colleagues provides yet another example of this phenomenon: Arizona's use of its civil commitment statutes to detain unrestorable, incompetent criminal defendants for whom other provisions have not been developed. This commentary provides a brief overview of other examples of the stretching of commitment laws, providing a broader context for viewing the findings of Levitt and colleagues.

Political abuse of psychiatry--an historical overview

The use of psychiatry for political purposes has been a major subject of debate within the world psychiatric community during the second half of the 20th century. The issue became prominent in the 1970s and 1980s due to the systematic political abuse of psychiatry in the Soviet Union, where approximately one-third of the political prisoners were locked up in psychiatric hospitals. The issue caused a major rift within the World Psychiatric Association, from which the Soviets were forced to withdraw in 1983. They returned conditionally in 1989. Political abuse of psychiatry took also place in other socialist countries and on a systematic scale in Romania, and during the first decade of the 21st century, it became clear that systematic political abuse of psychiatry is also happening in the People's Republic of China. The article discusses the historical background to these abuses and concludes that the issue had a major impact on the development of concepts regarding medical ethics and the professional responsibility of physicians.

[Common paths of psychiatry and forensic medicine--history and evolution of insanity defense concept from antiquity to modern times]

Forensic psychiatry and psychology were in their beginnings inseparably associated with the forensic medicine, constituting one of its related branches of knowledge. Progress and development of these disciplines, education and the practical application for the purposes of the law were a contribution of a several generations of forensic pathologists in the 19th and 20th centuries. One of the major issues of common interest was opinionating on the sanity of offenders. However, the problem of criminal responsibility of the mentally ill perpetrators dates back to much earlier times and has its roots in the distant beginnings of human civilization. In this paper, the history and evolution of the insanity concept (as a circumstance excluding the guilt of the offender) were presented, from the oldest theories to ideas underlying modern codifications.

Emergency compulsory admissions in the Netherlands: fluctuating patterns in Rotterdam, 1929-2005

This paper identifies the social changes and developments in public mental health that have contributed to fluctuations in the use of emergency compulsory admissions in Rotterdam, the Netherlands. Annual reports and administrative data over the years 1929-2005 indicate the impact of general and local factors. Demographic changes and statutory regulations were important general factors, but do not explain particular swings in the number of compulsory admissions. Key local factors were: the availability of alternative arrangements such as emergency centres and sheltered homes; an interpretation of the criteria for compulsory admissions shared by all disciplines involved; and better collaboration between services. These factors suggest that if the increasing use of compulsory admissions is to be reversed, a coordinated effort is needed.

Stigma, conscience, and science in psychiatry: past, present, and future

In his response to Reynolds and colleagues' "The Future of Psychiatry as Clinical Neuroscience," the author considers three themes prominent in the history of psychiatry: stigma, conscience, and science, considering each in the past, present, and into the future. A series of conclusions follow these historical perspectives. One, unraveling the web of stigma in the future depends more on moral, educational, and political achievements than neuroscientific ones. Two, psychiatry's future depends upon the public trust, which has fluctuated over its history and into the present era, during which legacies of undue influence and failed regulation have damaged this trust. While explaining the mechanisms for mental disorders is crucial, the returns from these scientific investments are decades away, and failures of conscience today undermine the vital public trust and impede psychiatry's abilities to immediately address the plight of the mentally ill. Three, the researcher-entrepreneur in perennial search of funding has replaced the old model of the curious researcher-practitioner. This drive for funding promotes hubris and failures of conscience in psychiatric science. Moreover, the information explosion and superspecialization of contemporary academic medicine has led to an intellectual fragmentation analogous to the service fragmentation at the beginnings of psychiatry. Attention to integrative synthesis of research information, as well as conscientious moral reflection on scientific advances, will promote humility over hubris: enhancing the public trust, assuring public confidence in psychiatric science, and empowering patients.

Folie a plusieurs: forensic cases from nineteenth-century Ireland

Folie a plusieurs is a syndrome in which two or more individuals share symptoms (e.g., delusions). This paper uses archival material to present and discuss forensic psychiatric cases of folie a plusieurs from nineteenth-century Ireland. The cases of three brothers who all 'became insane at the same time' and killed another brother illustrate: the role of organic factors in folie a plusieurs; the use of 'moral management' strategies; and the problem of tuberculosis in asylums. The case of one woman whose family 'all became insane at once' and killed one of her sons illustrates: the importance of identifying the 'primary' patient; the difficulties experienced by 'secondary' cases; and the limited therapeutic progress achieved in nineteenth-century asylums. While further historical study is required to explain the emergence of the concept of folie a plusieurs in the late nineteenth century, it is clear that, over one hundred years since the term came to prominence, 'communicated insanity' still presents substantive diagnostic, clinical and ethical challenges to mental health and judicial services.

'These strangers within our gates': race, psychiatry and mental illness among black Americans at St Elizabeths Hospital in Washington, DC, 1900-40

During the early decades of the twentieth century, William Alanson White and the medical staff at St Elizabeths Hospital in Washington, DC, developed an ambitious programme for US psychiatry wherein the profession would dedicate itself to the reconstitution of mentally-fit and socially-productive American citizens. The racist assumptions beneath this programme led most physicians at the institution to expect little more than deference, dependence and common labour from their black patients, preventing them from comprehending the impact of substandard and racially-segregated care. Black men and women were acutely aware of the injustices they faced. When they rejected elements of the hospital's medical regimen, these patients were also rejecting a social vision that consigned them to the margins of US civic life.

Court-ordered treatment for serious offenders with mental illness

The insanity defence was elaborated upon through case authority which paralleled the development of phenomenology and treatment of serious mental illnesses, particularly psychotic disorders. In 1843, the rules in McNaughton's Case established a clear formulation for determining whether a person with a mental illness may be held to have been not criminally responsible at the time of an offence. The current legislative scheme in Queensland incorporates the most modern application of the defence of insanity and diminished responsibility and provides the most efficient mechanism by which mentally ill offenders are diverted into care and treatment.

["The 'asylum', an undeniable need in social organization": questions about the commitment questionnaire at the São João de Deus Asylum]

The article relies on a collection of documents located at the Bahia State Archives and the city of Salvador's Santa Casa da Misericórdia Archives to gain an understanding of the history of asylums and of psychiatry in Bahia. The analysis is centered on one of the tools applied in taking anamneses, designed and employed by Bahian alienists at the São João de Deus Asylum in Salvador, Bahia, starting when the institute opened its doors in 1874. In a hermeneutic effort to view the symbolism of the past in light of the present, the article uses twenty of these questionnaires as a way of analyzing medical knowledge of madness and its treatment and further of identifying the methods devised for guiding daily life in an asylum.

The Mental Treatment Act 1945 in Ireland: an historical enquiry

The Mental Treatment Act 1945 had a decisive influence on the provision and development of psychiatric services in Ireland. This paper examines: (a) the historical and psychiatric backgrounds to the introduction of the Mental Treatment Act 1945; (b) the main provisions of the Act; and (c) the international context of the Act, especially in relation to institutional and legislative trends in other jurisdictions.

Compulsory psychiatric care in Sweden: development 1979-2002 and area variation

As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979-2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979-2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.

A family point of view: negotiating asylum care in Alberta, 1905-1930

This paper analyzes the meaning of mental illness and institutional care from a family point of view, using family correspondence and police reports about asylum admission of family members in Alberta at the beginning of the 20th century. Portraying the asylum as a place of negotiation, the analysis reveals that despite families' lack of authority over asylum admission, they nevertheless were active participants in structuring this new form of public care once it became available in Alberta. Families negotiated and contested existing medical and legal norms that structured asylum care in order to meet their own needs and demands. Categories of age, class, gender, race, and region intersected in shaping the family experience of mental illness. The paper concludes that families expected a newly built institution to provide relief of their social problems, which was at odds with the legal and medical norms regarding asylum admission.

Sacred radical of psychiatry

At least a dozen articles in this journal have referred directly to the psychiatry of Thomas Szasz, even favourably on occasions. Szasz makes no distinction between the occupational statuses of mental health workers and so his work is relevant to nurses. Szasz's central claims take on renewed vitality given recent developments in forensic care, especially in Britain. In this article, I criticize Szasz's rationale of what constitutes illness as opposed to disease. In addition, I question - in a nuanced way - his views on custodial psychiatry and his use of history to bolster his clams. I also comment on recent developments in biological research and their implications for diagnosing schizophrenia: further, I link the question of such diagnoses to Szasz's assertion that private contracts are the definitive test of what counts as mental illness. Lastly, I ask if improvements in mental health care contradict Szaszian criticisms and/or his seeming inability/unwillingness to acknowledge such changes.

Variations in the official prevalence and disposal of the insane in England under the poor law, 1850-1900

In the latter half of the nineteenth century, the vast majority of those recognized as insane were pauper insane. The local poor law officials and magistrates determined who was regarded as one of the pauper insane and what happened to them. This paper shows that there was considerable variation across England in the proportion of the population regarded as insane. Although most of the insane were committed to an asylum, a substantial minority (20-25%) were retained in the workhouse, and there was also considerable variation in the numbers dealt with in this way. Contrary to views expressed at the time and more recently, areas with higher levels of industrialization did not have higher rates of insanity. In fact the trend was definitely in the reverse direction. The factors that influenced the poor law authorities to retain the insane in the workhouse did not appear to be the additional expense of asylum care or the availability of beds in local asylums. The majority of the insane retained in the workhouse were idiots and imbeciles rather than lunatics, although some workhouses contained considerable numbers of the latter. The management of the insane in the workhouse was generally poor.

Basic problems of medical ethics in Russia in a historical context

The paper provides a short overview of key problems of medical ethics in the Russian and Soviet contexts--confidentiality, informed consent, human experimentation, abortion, euthanasia, organ and tissue transplantation, abuse of psychiatry. In Soviet ideology common interests were declared superior to private ones. Hence, medical confidentiality was viewed as a bourgeois survival. On the other hand, diagnosis was normally not disclosed to a patient in the case of an incurable disease (especially cancer). Due to the strong paternalistic traditions of Russian medicine the idea of informed consent is still disputed by many physicians. Abortions were first legalized in Soviet Russia in 1920. A brief history of this landmark event is provided. However, abortions were forbidden in 1936 and legalized again only in 1955. Active euthanasia was legalized in Soviet Russia in 1922 but for a short period. Federal law regulating human transplantation was adopted only in 1992 and based on the presumed consent model. Until then forensic autopsy and procurement of cadaver organs were viewed as equal procedures. In 1960s-1980s there was a practice of declaring political dissidents insane in their involuntary treatment.

Psychiatry in the East African colonies: a background to confinement

This article is concerned with the discipline of psychiatry in colonial East Africa as it emerged out of the crime and disorder problem to become an intellectually significant 'East African School' of psychiatry. The process of lunacy certification, in particular, provides a snapshot of the medical and political tensions that existed among the medical establishment, the prison system and the colonial courts, all of whom sought to define collective African behaviour. This historical article utilises archaic terminology, such as 'lunatic' or 'lunacy', as these categories were in use at the time.

Modern psychiatry in India: the British role in establishing an Asian system, 1858-1947

Four broad phases can be traced in the development of modern psychiatry in India. After briefly considering the outline of each of these phases this article will focus its attention on the second and third. It will be argued through tracing the trends in patient admission, treatment regimes and the organisation of the asylum system in these years that the foundations of modern psychiatry were laid in India in the period 1858 to 1947 and that the modern psychiatric system in India as it is today, although it has evolved since Independence in 1947, continues in significant ways to be shaped by the colonial period.

Fitness to be sentenced: a historical, comparative and practical review

A Canadian judicial decision recently held that a person convicted of a criminal offence who suffered a substantial deterioration in mental condition since the trial could be found unfit to be sentenced. The court based its conclusion on both historical arguments and the Canadian Charter of Rights and Freedoms. There are compelling justifications for recognizing this concept. The paper looks at the history of fitness and how the sentencing phase became disconnected from claims of unfitness in the late 19th century. It then considers theoretical justifications based on fairness, viewing sentencing as a moral discourse, and the effect of the Canadian Charter of Rights and Freedoms. Because of the number of practical questions that need to be addressed before implementing a concept of unfitness at the sentencing stage, the paper looks at some common law jurisdictions for guidance: Australia, New Zealand, and the American states of New York, Illinois, Connecticut, and Ohio. From these comparisons comes the idea of a "provisional cap". That is, the recognition of unfitness at the sentencing stage should be followed by a form of sentencing that takes into account the gravity of the offence, the prosecutor's position, any relevant aggravating or mitigating factors that can be adduced, and then results in a "provisional" sentence, whether custodial or community-based, which stays in effect until the offender becomes fit. The paper ends with a model that incorporates this approach while providing both that offenders will be confined, if necessary, in hospitals and not prisons, and also that the dispositions will be reviewed annually to ensure that the least restrictive and least onerous sanctions are imposed.