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Entry from Central State Hospital Admission Book, 1858 [125 kb] Fortunately, one of Dr. James Athon, required his medical staff to take detailed notes on the moral causes of each patient's mental illness, which appear in over fifty volumes of admission books and prescription books.

These rich, detailed, and uncomfortably honest patient histories cast aspersions on many of the social, political, economic, and religious realities of nineteenth-century America.

The Homicide Act 1957 is the statutory basis for the defense of diminished responsibility in England and Wales, whereas in Scotland it is a product of case law.

The number of findings of diminished responsibility has been matched by a fall in unfitness to plead and insanity findings (Walker, 1968).

It is also contrasted with a finding that a defendant cannot stand trial in a criminal case because a mental disease prevents him or her from effectively assisting counsel, from a civil finding in trusts and estates where a will is nullified because it was made when a mental disorder prevented a testator from recognizing the natural objects of their bounty, and from involuntary civil commitment to a mental institution, when anyone is found to be gravely disabled or to be a danger to themselves or to others.In the nineteenth century, the term insanity represented a broad spectrum of mental disorders as diverse as schizophrenia to the most severe of sociopathic disorders.What did nineteenth-century physicians think was at the heart of insanity?Causes of Insanity, Annual Report, 1853 [78 kb] Many physicians suggested that these social problems were a direct result of the social, economic, and political instability wrought by Jacksonian democracy, civil war, and industrialization.As historian Charles Rothman has compellingly argued, unprecedented social and economic fluidity in the mid-nineteenth century compelled Americans, poor and rich, to aspire for more, and many physicians interpreted this climbing of the proverbial ladder as excessive and pathological behavior.The defense is based on evaluations by forensic mental health professionals with the appropriate test according to the jurisdiction.Their testimony guides the jury, but they are not allowed to testify to the accused's criminal responsibility, as this is a matter for the jury to decide.Being incapable of distinguishing right from wrong is one basis for being found to be legally insane as a criminal defense.(or, more frequently, diminished capacity), may lead to reduced charges or reduced sentences.Legal definitions of insanity or mental disorder are varied, and include the M'Naghten Rule, the Durham rule, the 1953 British Royal Commission on Capital Punishment report, the ALI rule (American Legal Institute Model Penal Code rule), and other provisions, often relating to a lack of mens rea ("guilty mind").In the criminal laws of Australia and Canada, statutory legislation enshrines the M'Naghten Rules, with the terms defense of mental disorder, defense of mental illness or not criminally responsible by reason of mental disorder employed.

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