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July 17, 1996

Witnessing Insanity: Madness and Mad-Doctors in the English Court

Author Affiliations

Harvard Medical School Cambridge, Mass

JAMA. 1996;276(3):252. doi:10.1001/jama.1996.03540030086040

This interesting work of intellectual history articulates a point of view with which I disagree, as will most physicians. Nonetheless, it is enjoyable, thought-provoking, and important. Its scope is far beyond its modest title. Witnessing Insanity has clear implications beyond psychiatry and forensic psychiatry for the practicing clinician coping daily with managed care receivers who question "medical necessity."

Mr Eigen, a sociologist, has set out to systematically investigate medical testimony in British insanity trials from its beginnings in 1760 through 1843. It was in 1843 that the "McNaughton rule" for insanity was formulated, thereby setting forth a legal standard that medical testimony had to address. Perhaps most enlightening, one learns that the philosopher John Locke, so influential to the American revolutionary founding fathers as expressed in the Declaration of Independence and the Constitution, was also remarkably influential in the emerging field of medical psychology. Thus, writes Eigen, "Locke's schema and