Disease of the mind

Presumption of sanity and burden of proof

Sanity is a rebuttable presumption and the burden of proof is on the party relying upon it; the standard of proof is on a balance of probabilities, that is to say that mental incapacity is more likely than not. If this burden is successfully discharged, the party relying upon it is entitled to succeed. In Lord Denning's judgement in Bratty v Attorney-General for Northern Ireland 1963 AC 386, whenever the defendant makes an issue of his state of mind, the prosecution can adduce evidence of insanity. However, this will normally only arise to negate the defence case when automatismor diminished responsibility is in issue. In practical terms, the defence will be more likely to raise the issue of mental incapacity to negate or minimise criminal liability. In R v Clarke 1972 1 All E R 219 a defendant charged with a shoplifting claimed she had no mens rea because she had absent-mindedly walked out of the shop without paying because she suffered from depression. When the prosecution attempted to adduce evidence that this constituted insanity within the Rules, she changed her plea to guilty, but on appeal the Court ruled that she had been merely denying mens rea rather than raising a defence under the Rules and her conviction was quashed. The general rule was stated that the Rules apply only to cases in which the defect of reason is substantial.

Disease of the mind

Whether a particular condition amounts to a disease of the mind within the Rules is not a medical but a legal question to be decided in accordance with the ordinary rules of interpretation. It seems that any disease which produces a malfunctioning of the mind is a disease of the mind and need not be a disease of the brain itself. The term has been held to cover numerous conditions:

· R v Kemp 1957 1 QB 399: arteriosclerosis or a hardening of the arteries caused loss of control during which the defendant attacked his wife with a hammer. This was an internal condition and a disease of the mind.

· R v Sullivan 1984 AC 156 during an epileptic episode, the defendant caused grievous bodily harm: epilepsy was an internal condition and a disease of the mind, and the fact that the state was transitory was irrelevant.

· R v Quick & Paddison 1973 3 AER 397 a diabetic committed an assault while in a state of hypoglycaemia caused by the insulin he had taken, the alcohol he had consumed and not eating properly. It was ruled that the judge should have left the defence of automatism open to him, so his conviction was quashed (he had pleaded guilty rather than not guilty by reason of insanity). This was where the internal/external divide doctrine was first expressed, probably due to judicial reluctance to hospitalise someone for a condition that could be cured by a sugar lump. It is doubtful that a jury would have accepted a defence of automatism, but nonetheless the issue should have been left to them.

· R v Hennessy 1989) 1 WLR 287 a diabetic stole a car and drove it while suffering from a mild attack of hyperglycaemia caused by stress and a failure to take his insulin. Lane LCJ said at 294

In our judgment, stress, anxiety and depression can no doubt be the result of the operation of external factors, but they are not, it seems to us, in themselves separately or together external factors of the kind capable in law of causing or contributing to a state of automatism. They constitute a state of mind which is prone to recur. They lack the feature of novelty or accident, which is the basis of the distinction drawn by Lord Diplock in R v Sullivan 1984 AC 156, 172. It is contrary to the observations of Devlin J., to which we have just referred in Hill v Baxter 1958) 1 QB 277, 285. It does not, in our judgment, come within the scope of the exception of some external physical factor such as a blow on the head or the administration of an anesthetic.

· In Bratty, Lord Denning observed obiter that a crime committed while sleepwalking would appear to him to be one committed as an automaton. However, the ruling in R v Sullivan that diseases of the mind need have no permanence led many academics to suggest that sleepwalkers might well be found to be suffering from a disease of the mind with internal causes unless there was clear evidence of an external causal factor.

· In R v Burgess 1991 2 WLR 1206 the Court of Appeal ruled that the defendant, who wounded a woman by hitting her with a video recorder while sleepwalking, was insane under the M'Naghten Rules. Lord Lane said, "We accept that sleep is a normal condition, but the evidence in the instant case indicates that sleepwalking, and particularly violence in sleep, is not normal."

The courts have clearly drawn a distinction between internal and external factors affecting a defendant's mental condition. This is partly based on risk of recurrence, but the distinction between insanity and automatism is difficult because the distinction between internal and external divide is difficult. Many diseases consist of a predisposition, considered an internal cause, combined with a precipitant, which would be considered an external cause. Actions committed while sleepwalking would normally be considered as "non-insane automatism", but often alcohol and stress trigger bouts of sleepwalking and make them more likely to be violent. The diabetic who takes insulin but does not eat properly - is that an internal or external cause?

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