PRIVATE LIBRARY 
 
 — OF" 
 
 COMPLIMENTS OF THE AUTHOR. 
 
 Feigned Insanity. 
 
 REPORT OF THREE CASES, 
 
 BY WILLIAM FRANCIS DREWRYs M. D., 
 
 OF PETEESBURG, VA., 
 
 First Assistant Physician Central State Hospital. 
 
Digitized by the Internet Archive 
 in 2014 
 
 https://archive.org/details/feignedinsanityrOOdrew 
 
FEIGNED insanity; 
 
 BY WILLIAM FliANCIS DREWliY, M. D., 
 OF PETERSJU KtJ, VA., 
 
 First Assistant Physiaian Central State Hospital. 
 
 The simulation of iusaiiity is iiot an iouovation peculiar to 
 Dioderu day schemers, though it is now Imiuently resorted to 
 by designing criminals. 
 
 In the sacred writings it is recorded that the Shepherd King 
 of Israel "changed his behavior and feigned himself mad and 
 scrabbled on the doors of the gate, and let his spittle fall down 
 upon his beard , ' ' because he was ' ^sore afraid of the King of Gath . ' ' 
 
 In order to escape the Trojan war, Ulysses feigned insanity 
 by ploughing the seashore and sowing salt instead of corn, and 
 and Lucius Junius Brutus, it is said, played the imbecile for a 
 purpose. 
 
 To detect simulation and to establish the requisite proof of 
 it, have at all times been matters of more or less dif^icult3^ Cas- 
 per met with many cases of the sort and appreciated the diffi- 
 culties which they presented. Says Hammond: "N^o one, no 
 matter how skillful an alienist he may be, is beyond the point of 
 being imposed upon for a short time by persons assuming to have 
 certain forms of mental derangement. Snell remarks that if a 
 simulator preserves a complete passiveness and an obstinate si- 
 lence, it is not impossible that insanitj^ may be so perfectly sim- 
 ulated that detection may not be accomplished. Conolly I^or- 
 man regards the question of simulation of insanity as "one of the 
 most difficult with which alienists have to deal, one requiring 
 much experience, acumen and sagacity, if a satisfactory deci- 
 sion is to be arrived at." 
 
 In his work on "Sanity and Insanity," Merciersays: "There 
 is no form of insanity that may not be simulated by a case of 
 
 ■Read before the section of Neurology and Medical Jurisprudeuce, 
 American Medical Association, meeting at Atlanta, May, 1896. 
 
2 
 
 (Iriiiikouiiess; aud wbeu it is uot known, from other sources of 
 information, that these manifestations are due to drink, no ex- 
 pert in the world, however skillful, could distinguish between 
 the insanity that is due to alcoholic poison and the insanity that 
 is due to other causes." 
 
 Tardieu and others think, however, that nothing is more dif- 
 ficult to counterfeit than mental disease, and that the attempt to 
 deceive may be easily discovered by a careful observer. Conolly 
 asserts that he can ^'hardly imagine a case which would be proof 
 against an efficient system of observation. - 
 
 When we remember that, besides the fact that scores of crimi- 
 nals resort to the insanity dodge to escape merited punishment, 
 the truly insane sometimes simulate insanity, that simulation 
 itself may be an indication of mental alienation, and that occa- 
 sionally there is a tendency of feigned insanity after long dura- 
 tion to become real insanity, the question of accurate diagnosis 
 may not always be unattended with uncertainty and embarrass- 
 ment. To an experienced and competent alienist there will of 
 course seldom be any great difficulty in arriving at a correct con- 
 clusion, but to one with more or less limited knowledge of the 
 various manifestations of mental diseases, a clever imposter, with 
 the faculty of imitation well developed, would appear somewhat 
 in the nature of a psychical problem. 
 
 At all events, before giving a positive answer to so delicate 
 and important a question as whether one is insane, and there- 
 fore entitled to all possible humane consideration, or sane, and 
 consequently responsible for his illegal acts, a physician should 
 study methodically and scientifically the suspected case, keep- 
 ing his conscience pure and undefiled under all circumstances. 
 ^'His opinion," says an eminent authority, ^ ^should be founded 
 upon the conception of pure knowledge, based upon observation 
 and induction." 
 
 The question of disease — that and nothing more — is the one 
 for the physician to determine. Is the person, whose legal or tes- 
 tamentary responsibility is in doubt, insane — is his mind affected 
 by disease f That's the problem, the solution of which devolves 
 upon the physician. Says Bucknill: ''The element of disease 
 in abnormal conditions of mind is the touchstone of irresponsi- 
 bility aud the detection of its existence or non-existence, is the 
 peculiar and oftentimes the difficult task of the pyschologist." 
 
 So, view the matter in any way you will, it can be only a 
 question of diagnosis. 
 
8 
 
 CASE 1. 
 
 In February, 1895, Isaiah P. was indicted on the charge of 
 house-breaking and larceny. While in jail awaiting his trial in 
 the hustings court of a Virginia city, he suddenly began acting 
 so strangely that doubt was entertained regarding his mental 
 condition. Upon being arraigned in court his behavior was so 
 utterly at variance with that of an ordinary sane man, he was 
 remanded to jail and the trial of his case postponed, so that his 
 mental condition might be investigated. 
 
 The judge appointed the writer to ascertain v/hether or not the 
 prisoner was insane. Whereupon I visited him several times, 
 dealt with him not in the role of a secret detective, but in that of 
 an impartial physician, and as such proceeded systematically to 
 inform myself as full}' as possible of his history and symptoms. 
 
 Sistory and Heredity. — Isaiah was born, in 1857, of negro par- 
 entage. There was nothing of special interest connected with 
 his early life. From childhood he was a bad, indolent fellow. 
 Only two of his family were ever afflicted with any form of neu- 
 rosis or of psychosis. His mother, at sixty -five, was sent to an 
 asylum in a state of senile dementia. A younger sister died of 
 phthisis pulmonalis, complicated with melancholia, while in 
 a hospital. 
 
 During a spree Isaiah received a blow on the right side of his 
 head, which produced a depressed fracture, but under careful 
 surgical treatment he made a complete recovery, the only visible 
 results remaining being a slight depression in the cranium. On 
 more than one occasion he was suspected of larceny, and finally, 
 in 1888, was convicted and sentenced to five years confinement 
 in the State penitentiary. 
 
 It was claimed by his family that he had had, since the blow 
 on the head, several epileptic fits and been at times ''curious in 
 his ways." But in the absence of corroborative evidence these 
 statements were accepted with a degree of reserve. 
 
 Appearance, Manner and Symptoms. — A careful physical exam- 
 ination revealed nothing of special pathologic import. His 
 bodily condition was about normal. 
 
 He came into my presence with an air of exagerated excite- 
 ment, moved about restlessly, took no notice of his surround- 
 ings, looked wild and uneasy, talked incessantly and foolishly. 
 The almost exclusive subject of his foolish, incoherent gibberish 
 was locusts. He talked about locusts nearly all the time, but when 
 questioned he gave answers foreign to the subject of his apparent 
 
4 
 
 or assiiiiied deliisioii, saying- he did not uiiderstaud what I 
 meant. All questions were answered very slowly and hesita- 
 tingly. When T told him my bnsiness his incoherence and rest- 
 lessness became intensified. When unobserved he became 
 quiet and composed. 
 
 Odd sensations in his head were frequently complained of. 
 He would put his hand to his head and say, "something is 
 scrambling about in here.'' 
 
 Memory and intelligence, to all appearances, were absolutely 
 lost. Apparently he recalled nothing that had ever happened, 
 nor remembered any person or place he had ever seen. He could 
 not or would not distinguish one piece of money from another, 
 nor tell a man from a woman. 
 
 To every question he gave a negative or an absurd reply. For 
 instance: 
 
 (Question — Where were you born 1 
 
 Ansiver — Caught ninety-nine locusts to-day. 
 
 Question — How do you feel to-day? 
 
 Answer — Eat locusts with butter. 
 
 Question. Let me see your tongue? 
 
 Answer — Holds up his foot. 
 
 Question — Did you sleep well last night? 
 
 Answer — Tell him all right. Here they come. 
 
 Question — Tell me about the locusts ? 
 
 Answer — Had bread and shucl^s for dinner. 
 
 Question — But what of the locusts f 
 
 Answer — I donH understand yon. 
 
 Question — How long has your mind been affected this way ? 
 
 Answer — Some say forty-nine years. I say one hundred. 
 
 Question — Have you heard from home lately ? 
 
 Answer — Fell in the river last night. The locusts are rolling down 
 the mountains. Let them roll. 
 
 He slept well several hours every night, and frequently in the 
 daytime after he had become very tired from constant exertion 
 and excitement. 
 
 I took occasion to remark in an undertone to the jailor that, 
 if the patient were to sing, become uoisy at night, destructive to 
 clothing, filthy in his habits, devoid of the sense of pain, my be- 
 lief in his insanity would be confirmed. A few days later Isaiah 
 had become so noisy and filthy at night that he had to be iso- 
 lated. He had tried to be wakeful, but, negro-like, he soon fell 
 asleep. His clothes were torn, shoes thrown away, coat reversed. 
 
&G. T thrust a needle into his iiesh at various points, without 
 making any perceptible impression. Said he did not feel any 
 pain at all. A few minutes later, when a needle was suddenly 
 struck into his back, he forgot to be insensible to pain, and con- 
 sequently jumped some distance. 
 
 My notes show many and various evidences of Isaiah's clumsy 
 effort to ''play crazy," but the above is quite sufficient to prove 
 beyond any doubt, similation. I had no trouble in detecting the 
 fraud. 
 
 For two months — in fact, until the day he was taken to the 
 penitentiary to serve out a 23 -year sentence — he continued his 
 efforts to deceive. Finally, however, he acknowledged the at- 
 tempted fraud. 
 
 In my statement to the Court and jury I gave, in substance, 
 the following as the grounds upon which I based my opinions : 
 
 1. There was no prodromal stage of indisposition, malaise or de- 
 pression preceding the sudden outbreak. The attack occurred in 
 the midst of normal health . He had few symptoms of any form 
 of insanity which might begin somewhat suddenly, viz: transi- 
 tory mania, epileptic mania, confusional insanity, acute halluci- 
 natory insanity, alcoholic mania, none of which it is possible to 
 counterfeit. Then, the fixedness of the form of delusion he tried 
 to imitate would exclude any of the above types of insanity. 
 
 2. Sudden development of a fixed delusion regarding one par- 
 ticular subject is not consistent with the clinical history of any 
 known form of insanity; for paranoia, monomania or delusional 
 insanity, is of slow and gradual development and generally un- 
 attended with any special excitement, loss of intelligence, &c. 
 
 3. If he were trying to appear a paranoiac or monomaniac, he 
 overlooked many essential points; for instance, when questioned 
 regarding his delusion, he invariably gave an answer entirely 
 foreign to the subject; and the peculiarity of expression which 
 so strongly marks that class of cases, was entirely wanting; and, 
 furthermore, there was no excitement or irritability of temper 
 when contradicted. 
 
 4. Loss of memory, reason and intelligence would occur in 
 dementia, but the quickness with which he carried out my sug- 
 gestions regarding the "lacking symptoms" of insanity, to say 
 nothing about his appearance and general shrewdness, would 
 preclude any suspicion of mental decay. 
 
 5. Contrary to what is observed in acute mania and some other 
 forms of insanity, there was no sign of insomnia. The more in 
 
6 
 
 teuse his restlessuess, the more profoimd the sleep which fol- 
 lowed . 
 
 6. The hesitancy, extravagance and silliness with which he 
 replied to simple ((uestions; the absurd, disordered ideas which 
 llowed slowly and thoughtfully would not be exhibited in the 
 real maniac, whose ideas form and flow rapidly, disconnectedly, 
 and are not devoid of sense. 
 
 7. There were no physical symptoms upon which to base a di- 
 agnosis of either functional or organic disease of the brain. The 
 injury to the head had left no perceptible ill results, motor, sen- 
 sory or mental. A slight depression marked the site of the blow. 
 
 8. The insanity of his mother being a psychosis of old age, could 
 have but little effect, if any, in the offspring of her early life. 
 But the facts that his mother was insane and that he had an in- 
 sane and phthisical sister might be considered, in connection 
 with the possible effects of the blow on the head, sufficient 
 grounds upon which a neurotic diathesis or nervous instability 
 might be based. It is of course possible that the head injury 
 might have caused some moral deficiency. 
 
 9. The order of development and the assumed symptoms failed 
 to conform to the complete clinical picture of any recognized type 
 of mental disease. 
 
 10. The motive for feigning was not overlooked, though that 
 was of secondary importance when compared with the history 
 and symptoms of the case. 
 
 CASE 2. 
 
 Another instance of a criminal trying to escape the stern edict 
 of the law by pretending to be insane, has lately come under my 
 personal observation. In this case, however, the ultimate pur- 
 pose of the malingerer was accomplished. 
 
 Isaac H., a negro youth, had served a few months of an 18- 
 year sentence in the state prison, for murder. He assumed the 
 role of a madman, and by taking advantage of the lax and crude 
 method of adjudging one insane in Virginia, succeeded in 
 gaining admission to the insane asylum, where no special ar- 
 rangements are provided for the custody of insane criminals. 
 Every possible precaution was exercised to prevent his escape, 
 yet he, after a short sojourn, very ingeniously gained his 
 liberty and has never since been heard of. We had diagnosed 
 the case correctly and were contemplating returning the prisoner 
 to his legitimate abode. I have not time here to make a thor- 
 ough analysis of the case. Suffice it to say, he so far overacted 
 
7 
 
 the part, and behaved so differently from any other case of acute 
 mania — the form of insanity he was trying- to counterfeit — the 
 deception was too flagrant. 
 
 The history of the case, the clumsy, overacted symptoms, the 
 motive, were all carefully studied, and by a process of elimina- 
 tion, no type of insanity was left to fit his case. In the words of 
 the distinguished Dr. Ohapin, of Philadelphia, "The method of 
 arriving at a conclusion is, bring together all the features in the 
 history and manifestations of the case and then decide whether 
 the case corresponds to a type of insanity, which in all of its 
 features could not be simulated except by a trained alienist. In 
 this way a mistake will rarely be made." 
 
 CASE 
 
 Some years ago there was admitted into the Central Hospital 
 a 3^oung colored girl, of intelligence above the average of her 
 race, and with a physical formation well nigh perfect. Her case 
 had been diagnosed "epileptic insanity." 
 
 It was some time before I had an opportunity of seeing her 
 "in a fit." From the post-epileptic condition I had serious 
 doubts about the genuineness of the epilepsy. Eventually I saw 
 her repeatedly in her "terrible attacks," as her family had des- 
 ignated the seizures. 
 
 She would cry out suddenly, then fall, snap her jaws together, 
 make a noise like the bark of a dog, foam at the mouth, and act 
 most maniacally, &c. Then she would pass in a convulsive 
 state, jerk violently, tear off all her clothes, assume the opis- 
 thotonos position, grind her teeth, strike and snap at everything 
 in reach, and finally pass into a quiet sleep. These violent at- 
 tacks would continue sometimes for an hour or two, after which 
 the patient would become quiet and composed, her only com- 
 plaint being that she felt sore. Said she knew nothing of the at 
 tacks, when they came on or how they affected her, but ex- 
 pressed great mortification on account of her affliction. 
 
 I noticed that the fall was rather guarded, that she never bit 
 her tongue or hurt herself in any way, that the sphincters were 
 never relaxed, that the pupils were in every way normal, the 
 iris not insensible to light. It was evident that sensory percep- 
 tion existed. She became bathed in hot perspiration, and 
 seemed to be well nigh exhausted. 
 
 The assumed tonic and clonic convulsions were by no means 
 like those seen in real epilepsy. The post-epileptic condition 
 she made no attempt to imitate. 
 
8 
 
 The girl was carefully uursed for some time, but after watch- 
 ing her curious manoeuvres for a few times, I told her that she 
 was feigning and that the next attack she had I should put her 
 in a room and pay no attention to her whatever. My threat was 
 promptly carried into execution, and the effect was all that could 
 have been desired. 
 
 She was soon sent home, got married, though has never had 
 any children, and has ever since remained free from that ''epi- 
 leptic insanity" which she palmed oft* so successfully on some of 
 her friends for the sole purpose, as far as I could discern, of 
 arousing sympathy. There was doubtless some hysteria in her 
 case. 
 
 That there is no established rule or test by which feigned in- 
 sanity may be detected, but that each case must be decided upon 
 according to the history and symptoms presented, cannot be well 
 denied. Alienists everywhere will bear me out in these asser- 
 tions. The individual whose sanity or insanity is being ques- 
 tioned should constitute the chief object of the investigation. 
 
 Whenever there is any doubt about the mental condition of 
 one charged with crime, it would be well, in my humble judg- 
 ment, for the court to select a committee of competent alienists 
 to investigate the case and report in writing the result of their 
 examinations and deliberations. This need not preclude a cross- 
 examination . 
 
 In Russia and elsewhere methods similar to this prevail. In 
 some of the countries there is a regular court physician who de- 
 cides all doubtful medical cases. It has been advocated in some 
 quarters that there be appointed state experts in insanity to act 
 in all cases where an element of uncertainty exists. 
 
 But the best plan, probably, would be to transfer the suspect 
 to an insane asylum and keep him there, under proper safe- 
 guard, for a specified time, in order that the attending physicians 
 may determine the question of real or counterfeited insanity. 
 
 For the reasons that the position often taken by lawyers is so 
 entirely at variance with the true conception of the disease — in- 
 sanity, — that medical witnesses, who have no special knowl- 
 edge of insanity, are often called upon to give expert testimony, 
 and that physicians are sometimes utilized by shrewd counsel, 
 for partizan or for sinister purposes, that juries composed entirely 
 of laymen are not competent to try a case which involves a ques- 
 tion of mental alienation — brain disease, — and finally and chiefly, 
 that the ends of justice and mercy are sometimes thwarted, our 
 system of medical jurisprudence of insanity is in need of revision. 
 
r 
 
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