MEDICO-LEGAL ASPECT OF

DISTURBANCE OF MENTALITY

I. INSANITY

Sociological viewpoint, insanity is the persistent inability through mental causes to adapt oneself
to the ordinary environment. It is the loss of power of the individual to regulate his actions and
conduct according to the rules of society in which he moves.

Insanity in medicine is the prolonged departure of the individual from his natural mental state
arising from bodily disease.

Insanity in law covers nothing more than the relation of a person and the particular act which is
the subject of judicial investigation.

Legal Importance of the Determination

CIVIL CODE

a. Insanity is a restriction on the capacity of a natural person to act:

Art. 38, Civil Code — Minority, insanity or imbecility, the state of being a deaf-mute, prodigality
and civil interdiction are mere restrictions on capacity to act, and do not exempt the
incapacitated person from certain obligations, as when the latter arise from his acts or from
property relations, such as easements.

b. Insanity modifies or limits the capacity of a natural person to act:

Art. 38, Civil Code — Minority, insanity or imbecility, the state of being a deaf-mute, prodigality
and civil interdiction are mere restrictions on capacity to act, and do not exempt the
incapacitated person from certain obligations, as when the latter arise from his acts or from
property relations, such as easements.

c. Insanity at the time of marriage of any or both parties is a ground for the annulment of
marriage:

Art. 85, Civil Code — A marriage may be annulled for any of the following causes; existing at
the time of marriage:

(3) That either party was of unsound mind, unless such party, after coming to reason, freely
cohabited with the other as husband or wife.
d. A testator must be of sound mind at the time of execution of a will:

Art. 798, Civil Code — In order to make a will it is essential that the testator be of sound mind at
the time of its execution.

Art. 799, Civil Code — To be of sound mind, it is not necessary that the testator be in full
possession of all his reasoning faculties, or that his mind be wholly unbroken, unimpaired, or
unshattered by disease, injury or other cause. It shall be sufficient if the testator was able at the
time of making the will to know the nature of the estate to be disposed of, the proper objects of
his bounty, and the character of the testamentary act.

Art. 800, Civil Code — The law presumes that every person is of sound mind, in the absence of
proof to the contrary. Succession is a legal mode by virtue of which the property, right and
obligations which in life belong to a person is acquired by his heirs.

e. A witness to a will must be of sound mind:

Art. 820, Civil Code — Any person of sound mind and of the age of eighteen years or more, and
not blind, deaf or dumb, and able to read and write, may be a witness to the execution of a will

f. Insanity of the testator is a ground for disallowance of a will:

Art. 839, Civil Code — The will shall be disallowed in any of the following cases:

(2) If the testator was insane, or otherwise mentally incapable of making a will, at the time of its
execution.

g. An insane cannot give consent to a contract:

Art. 1327, Civil Code — The following cannot give consent toa contract:
(1) Unemancipated minors:
(2) Insane or demented persons, and deaf-mutes who do not know how to write.

h. The guardian or the insane himself, if there is no parent or guardian shall be held liable for
damages due to his insanity:

Art. 2180, Par. 3, Civil Code — Guardians are liable for damages caused by the minors or
incapacitated persons who are under their authority and live in their company.

Art. 2182, Civil Code — If the minor or insane person causing the damage has no parents or
guardian, the minor or insane person shall be answerable with his own property in an action
against him where a guardian ad litem shall be appointed. A guardian ad litem is a guardian
appointed by the court to prosecute or defend a suit on behalf of a party incapacitated because
of minority or insanity.
REVISED PENAL CODE

a. Insanity exempts a person from criminal liability:

Art. 12, Revised Penal Code — Circumstance which exempt from criminal liability — The
following are exempt from criminal liability:

(1) An imbecile or an insane person, unless the latter has acted during a lucid interval.

b. A person who becomes insane after the final sentence:

Art. 79, Revised Penal Code — Suspension of the execution and service of the penalties in
case of insanity — When a convict shall become insane or an imbecile after final sentence has
been pronounced, the execution of said sentence shall be suspended only with regard to the
personal penalty, the provisions of the second paragraph of circumstances number 1 of article
12 being observed in the corresponding cases.

If at any time the convict shall recover his reason, his sentence shall be executed, unless the
penalty shall have been prescribed in accordance with the provision of this Code.

The respective provisions of this section shall also be observed if the insanity or imbecility
occurs while the convict is serving his sentence.

RULES OF COURT

a. A guardian on the person of the insane must be appointed:

Rule 92, Sec. 2, Rules of Court — Meaning of word "incompetent" — Under this rule, the word
'incompetent" includes. . . .those who are of unsound mind, even though they have lucid
intervals.

Rule 93, Sec. 1, Rules of Court — Who may petition for appointment of guardian for resident —
Any relative, friend, or other person on behalf of a resident minor or incompetent who has no
parent or lawful guardian. . . .An officer of the Federal Administration of the United States in the
Philippines may also file a petition in favor of a ward thereof, and the Director of Health, in favor
of an insane person who should be hospitalized, or in favor of an isolated leper,

b. An insane cannot be a witness in court:

Rule 130, Sec. 19 (a), Rules of Court — Physical disqualification — The following persons
cannot be a witness:

(a) Those who are of unsound mind at the time of their production for examination, to such a
degree as to be incapable of perceiving and making known their perception to others.
MANIFESTATION OF MENTAL DISORDERS

1. Disorder of Cognition (Knowing):

a. Disorder in Perception:

(1) Illusion — a false interpretation of an external stimulus. It may be manifested with the sense
of sight, hearing, taste, touch and smell.
Example: A dragonfly may be considered a vampire bat.

(2) Hallucination​ — An erroneous perception without external object of stimulus.

Some Types of Hallucination:

(a) Visual— Seeing things although not present.
(b ) Auditory — Hearing voice in absolute silence.
(c) Olfactory — False perception of smell.
(d) Gustatory — False perception of taste.

b. Disorder of Memory​:

(1) Dementia — A form of insanity resulting from degeneration or disorder of the brain
characterized by general mental weakness, forgetfulness, loss of coherence, and total inability
to reason but not accompanied by delusion or uncontrollable impulse (Hibbard v. Baker, 104
N.W. 339, 141 Mich. 124).

Some Types of Dementia:

(a) Acute Dementia — a form of temporary dementia, occurring in young people and induced by
conditions likely to produce that state, like malnutrition, overwork, dissipation or too rapid
growth.

(b) Senile Dementia — Occurring in advanced age and characterized by loss of memory, with
childish and silly behavior and physical degeneration.

(2) Amnesia (Loss of Memory):

(a) Anterograde Amnesia — Loss of memory of recent event.

(b ) Retrograde Amnesia — Loss of memory of past events and observed in trauma of the head.
c. Disorder of Content of Thought​:

(​1) Delusion ​—

A false or erroneous belief in something which is not a fact. A person suffering from delusion is
not always insane.

Some Types of Delusion:

(a) Delusion of Grandeur ("Delirium of Grandeur', Megalomania or "folie de grandeur") —

Erroneous belief that he is in possession of great power, wealth, wisdom, physical strength, etc.
It is not always a sign of insanity. A person may think he is a king and dresses and acts
as such.

(b ) Delusion of Persecution — A false belief that one is being persecuted. A person may feel
that he is being poisoned and prepares for his coming end.

(2) Obsession ​— Thought and impulse which continually occur in the person's mind despite all
his attempts to keep them out. It is an idea constantly obtruding on the consciousness in spite of
efforts to drive them away from his mind.

A person may lock the door of his bedroom and go to bed. While in bed he may get up to see if
he has locked the door. He may go to bed again and again think and see whether the door is
locked. He may repeat the act the whole night.

d. Disorder on the Trend of Thought:

(1) Mania​ — A state of excitement accompanied by exaltation or a feeling of well-being which is

out of harmony with the surrounding circumstances of the patient. The mind is hyperactive, with
"flight of ideas" which may amount to incoherency.

(2) Melancholia​ — Intense feeling of depression and misery which is unwarranted by his
physical condition and external environment. He is absorbed by his miserable thought. Aural
hallucination is common. Every patient suffering from melancholia is a potential suicide case.
2. Disorder of Emotion (Feeling):

a. Exaltation — Feeling of unwarranted well-being and happiness.

b. Depression — Feeling of miserable thought, that a calamitous incident occurred in his life,
something has gone wrong with his body functions and prefers to be quiet and in seclusion.

c. Apathy — Serious disregard of the surrounding environment.

d. Phobia — Excessive, irrational and uncontrollable fear of a perfectly natural situation or

object.

Some Types of Phobia:

Childbirth — Tocophobia
Crossing a bridge — Gephyrophobia
Daylight — Phengophobia
Drinking —Dipsophobia
Height — Acrophobia

3. Disorder of Volition or Conation (Doing​):

a. Impulsion or Impulse (Compulsion) — Sudden and irresistible force compelling a person to

the conscious performance of some action without motive or forethought. The person has no
power to control it, however bad the consequence may be.

Types of Impulsion (Compulsion Neurosis):

(1) Pyromania — An irresistible impulse to set things afire.

(2) Kleptomania — An irresistible impulse to steal articles of not much value.
(3) Mutilomania — An irresistible impulse to maim animals.
(5) Homicidal Impulse — An irresistible inclination or impulse to commit homicide prompted
usually by insane delusion either as a necessity of self-defense or avenging for justice, or as to
the patient being the appointed instrument of a superman justice
INSANITY AND CRIMINAL RESPONSIBILITY

Fundamental Principles in Criminal Responsibility:

1. A sane man is assumed to be wholly responsible for the consequence of his criminal act.

2. A person who commits a criminal act is presumed to be sane. The burden of proof lies on the
accused to prove that he is not sane and cannot be held responsible for his criminal act.

3. The crime is always considered to be an affair of the mind as well as the body and to make
an act or omission of a crime, there must be a criminal act (actus reus) and a criminal mind
(mens rea). This is inconsonance with the legal maxim that "actus facit reum nisi mens sit rea"
(There cannot be a guilty act unless there is a guilty mind).
Mental Illness may be an Exempting or Mitigating Circumstance to Criminal Liability:

1. As an Exempting Circumstance:

Art. 12, Revised Penal Code — Circumstances which exempt from criminal liability —

The following are exempt from criminal liability: 1. An imbecile or an insane person, unless the
latter has acted during a lucid interval. When the imbecile or an insane person has committed
an act which the law defines as a felony (delito), the court shall order his confinement in one of
the hospitals or asylums established for persons thus afflicted, which he shall not be permitted
to leave without first obtaining the permission of the same court.

Case Where Defense of Insanity were Upheld by Court:

An accused who committed homicide and has been known to be suffering from dementia
praecox with delusions that he was being molested sexually, or that his property was being
taken, was considered insane and exempted from criminal liability ​(People v. Bonoan, 64 Phil.
87).

The wife of the accused and her cousin testified that the accused was continuously out of his
mind for many years. The assistant district health officer who examined the accused testified
that he was suffering from violent mania and that condition could be present at the time he killed
the deceased. There was no motive for the accused to kill the deceased. The court considered
the accused insane ​(People v. Bascos, 44 Phil. 204).
2. As a Mitigating Circumstance:

Art. 13, Revised Penal Code — Mitigating circumstances — The following are mitigating
circumstances:

8. That the offender is deaf and dumb, blind or otherwise suffering from physical defect which
thus restricts his means of action, defense, or communication with his fellow beings.
9. Such illness of the offender as would diminish the exercise of the will-power of the offender
without however depriving him of consciousness of his acts.
10. And, finally, any other circumstance of a similar nature and analogous to those above
mentioned.

The fact that the accused is suffering from a mild behavioral disorder as a consequence of an
illness she had in early life is regarded as mitigating circumstance under Art. 13, Par. 8 or in
Par. 9 of the Revised Penal Code (​People v. Amit. 82 Phil. 820)

One who was suffering from acute neurosis which made him ill-tempered and easily angered
was entitled to the mitigating circumstance because illness diminished his exercise of will
power​ (People u. Carpenter C.A. G.R. 4168 Apr. 22, 1940).

Phase In The Criminal Act Where The Evidence Of Insanity Of The Accused Must Be
Established​:

The evidence of insanity must be referred to at the time preceding the act under prosecution or
to the very moment of its execution. In order to ascertain a person's mental condition at the time
of the act, it is permissible to receive evidence of the condition of his mind during a reasonable
period both before or after that time. To prove insanity, circumstantial evidence, if clear and
convincing, will suffice​ (People v. Bonoan, 64 Phil. 93).

“Schizophrenia is a chronic mental disorder characterized by inability to distinguish between

fantasy and reality, and often accompanied by hallucinations and delusions. A showing that an
accused is suffering from a mental disorder, however, does not automatically exonerate him
from the consequences of his act. Mere abnormality of the mental faculties will not exclude
imputability. xxx Insanity must relate to the time immediately preceding or simultaneous with the
commission of the offense with which the accused is charged. Otherwise, he must be adjudged
guilty for the said offense. In short, in order for the accused to be exempted from criminal liability
under a plea of insanity, he must categorically demonstrate that: (1) he was completely deprived
of intelligence because of his mental condition or illness; and (2) such complete deprivation of
intelligence must be manifest at the time or immediately before the commission of the offense​.”
Verdadero vs. People (G.R. No. 216021, March 2,2016)

The following rules have been adopted by courts to determine

whether an accused is suffering from insanity to exempt him from criminal liability :

1. Earlier Test for Insanity:

a. "Wild Beast Rule": A person is exempted from criminal liability if he is totally

deprived of his understanding and memory and knows no more than an infant, a brute, or a wild
beast of what he is doing.

Not universally accepted because:

a. Its application is limited to violent crimes against a person; and

b. It is quite hard to measure the aggressive behavior of a wild beast.

b. Delusion Rule​:

A person is not responsible for his act if he is suffering from delusion although he knows that his
act is wrong. This rule was applied to the James Hadfield case wherein the accused attempted
to kill King George III of England while entering the Drury Lane Theater. Hadfield was found to
be suffering from a delusion although he knew at the time that he was actually firing a gun at the
King.

A person with delusion may be insane but his suffering from delusion may not necessarily affect
his judgement in a particular act. If a person who is suffering from delusion commits an illegal
act which has no relation to the particular delusion from which he is suffering he must be
considered responsible for such an act as if he were sane.

2. Later Tests for Insanity:

a. McNaghten's Rule (1843​):

A defense on the ground of insanity can be established if it can be proven that at the time of
committing the act:
(1) The accused was laboring under such defect of reason or from a disease of the mind as not
to know the nature and quality of the act he was doing, or
(2) If he did know, he did not know that what he was doing was wrong.

Under the rule, before an accused can be exempted from criminal liability, it must be proven
first.

(a) That the accused was suffering from the disease of the mind. It is the psychiatrist who must
determine the presence of the disease of the mind, although what constitutes the disease is not
entirely clear.

(b) It must be proven that the accused did not know the nature and quality of the act he was
doing. A person who, on account of mental disease, did not know the nature and quality of his
act does not have criminal intent (mens rea).

(c) If the accused knew the nature and quality of the act, then it must be proven that he did not
know that what he was doing was wrong. "Wrong", insofar as McNaghten's Rule is concerned,
means contrary to law. The knowledge that the act was in violation of criminal law has been
held to be sufficient to justify holding the accused responsible.

b. Irresistible Impulse Rule​:

A person is considered insane when mental disease has rendered him incapable of restraining
himself, although he understands what he is doing and knows it is wrong.

c. Durham Rule

The accused is not criminally responsible if his act was the

product of mental disease or mental defect. The determination of criminal responsibility is based
on the answer to two questions:

(1) Is the defendant suffering from a mental disease or defect?

(2) If so, was his crime a product of the mental disease or defect?

d. Currens Rule​:

In order to make the accused not responsible for his act it must be proven that at the time of
committing the prohibited act the defendant, as a result of mental disease or defect, lacked
substantial capacity to conform his conduct to the requirements of the law which he has
allegedly violated.