DELINQUENCY AND MENTAL DEFECT (I)1.

By W. NORWOOD EAST.

It is proposed in this paper to deal briefly with a few points concerning criminal actions in association with mental deficiency. At the outset it should be recalled that for a considerable time past the fact has been recognised that in dealing with criminals, individual consideration is essential before any hope of success in treatment can be anticipated. This is appreciated by the judicial and prison authorities, no less than by others. From time to time one comes across passages in the writings of medical men and persons interested in sociological problems, which show that the authors still believe in the old legend that judicial authorities generally have in mind the desire and intention to inflict punishment on offenders indiscriminately, whereas in fact, punishment by means of imprisonment is usually, in modern times, the last resource of those who in a judicial capacity are responsible for the safety of the community. The writer, who has no reason to suppose his experience is uncommon, is frequently asked when in the witness-box what is, in his opinion, advisable in the best interests of a prisoner whom he cannot testify is insane or mentally defective, and for whose future the best provision is not obvious. And this question is put in the highest criminal courts as well as in courts of summary jurisdiction, and may refer also to the length of imprisonment under medical observation which seems desirable. To anyone in constant attendance in criminal courts the inclination to utilise the knowledge and experience of mental diseases acquired by the medical witness is obvious, a fact well known to many offenders, who at times enter prison with a psychological diagnosis ready to hand. Such was a case recently under observation and upon whose mental condition the court called for a report; the accused was remanded for a series of impudent and skilful frauds, and when arrested hoped to escape punishment, and deportation to his own country, because he informed me a medical man abroad had told him he was anti-social, which he was, and paranoidal which he was not.

1 A contribution to the Symposium presented at the Joint Meeting of the Educational Section and the Medical Section of the British Psychological Society, April 25th, 1923.

Med. Psych. III

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For years the work of the prison officials, administrative and medical, was hampered, as no means of dealing efficiently with the feeble-minded prisoners were available. Classification and special consideration and treatment apart from the other prisoners was carried out, and some defectives of the more stable type were so dealt with not entirely unsatisfactorily, but the unstable type with marked emotional and characterial defects became a burden to themselves and to those responsible for their welfare. Now, the duties of the prison medical officer relative to this class of prisoner become more and more limited to those of accurate diagnosis, and as accommodation for defectives increases one may hope that in the not far distant future this will constitute his sole duty towards them. Controversy has frequently arisen concerning the number of deficients or inefficients among the prison population. In the evidence given before the Royal Commission the estimate varied from the 3 per cent. given by the Medical Inspector of Prisons of that day— Dr now Sir Herbert Smalley-to the 18 per cent. to 20 per cent. given by an experienced prison medical officer, and the 18.9 per cent. and under of the Medical Investigators. It is probably a matter of general agreement at the present time, that these larger figures are inaccurate. Of 8392 prisoners received during a recent 12 months for trial or on remand, 755 were sent specially for medical observation and report as to their mental condition. Of these, 120 were found to be insane, 67 certifiable under the Mental Deficiency Act and 103 were considered to show lesser and uncertifiable degrees of mental disorder and defect, a total of 290. That is, of 8392 prisoners received on remand or for trial, 290 or 3-4 per cent. were mental inefficients. This figure should be slightly higher as no reports are called for or sent in some borderline cases, and a more accurate estimate for unconvicted prisoners would be I believe 5 per cent. Amongst convicted prisoners the figure should be less, as the remand prison sifts out the bulk of those suffering from mental disorder or defect, but it must ever be borne in mind in this connection that there still remain in prisons mental inefficients who are not certifiable under the Lunacy or Mental Deficiency Acts. A certain number of these cases are undoubtedly feeble-minded persons of middle age, in whom the absence of an early history prevents a certain diagnosis being made, others are mentally inefficient from bodily disease, syphilis, alcohol, privations, a past attack of insanity and the like.

The majority of defectives are dealt with of course by courts of summary jurisdiction, and the judicial authority acts on the medical and other evidence before him; but in those cases where more serious offences

have occurred, or where doubt as to the prisoner's guilt may exist, the trial may take place at Quarter Sessions or Assizes before a jury. Unlike cases of insanity, in whom the petty jury judge as to the existence of mental disease or not in the prisoner on the medical evidence put before them, and sometimes in spite of it, the state of mind of the defective prisoner is not a matter for their consideration. The Royal Commission and the whole body of judges recommended that no such verdict as "guilty but mentally defective" should be given. During the trial at Quarter Sessions or Assizes evidence may fall from witnesses for the prosecution, or the defence, suggesting mental defect on the part of the accused. Should he be found guilty, and if he has been on bail before trial, sentence may be postponed so that he may be under the observation of the prison medical officer, whose opinion may be given later. If the accused has been in custody whilst awaiting trial and defect has been diagnosed, the court is informed before trial of the medical officer's opinion, and he is called as a witness, usually after the verdict, if one of conviction has been returned. The court is then able, if satisfied, to act on the medical evidence and in sentencing the prisoner order his detention in a defective institution, but not for any specified time, instead of imprisonment for a definite period, this applying to all offences except treason and murder in whom the only sentence, unless insane, is death.

The assessment of mental deficiency on medical evidence in high grade cases would present in not a few cases some difficulty to a jury, should it be their function to return a verdict of "guilty but mentally defective." Their conception of mental disease and defect may lack both knowledge and experience. Not long since I gave evidence that I considered a prisoner to be insane because he believed a well-known London surgeon, his house-surgeon and the chaplain of the hospital where the prisoner had been treated, were conspiring together to make him a prostitute, that advertisements were inserted in the press to get him, by false representations, into a nursing home where he would be made a prostitute, that people followed him from town to town and spied upon him, that his persecutors tried to posion him and prevented him earning his own living, that I considered these were genuine insane delusions and the accused to be too confused to enable him to be fit to plead and stand his trial. His conduct and statements in court supported my opinion, and the jury returned a verdict that he was insane and unfit to plead; but a jury-woman-in-waiting was heard to remark that if she had been on the jury she would not have acquiesced in such a verdict, as delusions were not insanity. It is a fair inference that this lady would have had