By Dr David Laing Dawson
There can be no concept of sane without a concept of insane, as there can be no on without an off.
We use words to communicate and to express our emotions and reactions.
Sane/insane is a judgement we make of others, specifically the behaviour of others. Sane in common usage and in law is a default position, assumed, unless demonstrated otherwise.
When we ask how people usually make that judgement we find that we use two parameters: The first is the application of logic. We consider the goal, the purpose of the person’s actions, and then ask if that action could, logically, achieve that goal. The well known Einstein definition of insanity is of someone doing the same thing over and over while expecting different results. This fails the logic test, though we all might empathize a little.
The second is the application of empathy. We ask ourselves if we would or could behave in the same manner in the same circumstances.
In common use we deem a human behaviour as insane when it fails both tests.
The example often quoted is the observation of a man of age dressed in a business suit climbing a tree. We note that he is fleeing a bear and thus we judge, by logic and empathy, the action to be sane. On the other hand, he tells us he is avoiding a flea, we judge by logic and empathy the action to be insane, or perhaps there is a stage between the two we think of as simply, “not sane.”
In a similar vein, though the linguists and philosophers and psychologists can discuss many possible parameters that can be used for the distinction between normal and abnormal (statistical, actuarial, ideal, moral judgement, function…) in common use we tend to equate normal with predictable, and abnormal with unpredictable.
In the village old Joe is usually seen sitting on the bench in the square talking to himself. This becomes accepted as normal, and only when he doesn’t show up is the absence of Joe on the park bench perceived as abnormal.
In medicine the words normal and abnormal are used often (physical findings, tests). The parameter here is statistical or actuarial, with some element of predictability.
In psychiatry these two words (normal and abnormal), like “sane” or “insane”, are avoided, and replaced with such words as ‘usual’ and ‘unusual’, ‘functional’ or ‘dysfunctional’, which require an individual or social context and/or known history. i.e usual for this individual, or in this culture, or context. Or unusual and dysfunctional for this person to behave this way.
There is a paradox about sanity, or being sane, voiced before, and that is that someone truly sane occasionally doubts or questions his or her sanity (“am I really perceiving things as they are and coming to a logical, rational conclusion?”) while the truly insane person never doubts his sanity.
In my office the manic or psychotic patient has no doubts about the mental map he has drawn, his conclusions about the way the world works, and his place in it, be it messenger of God, or victim of the Deep State, but I, as a sane person, always do have doubts. As a sane person I do not need reminders by the the anti-psychiatry folks that my conclusions, my diagnoses, the advice and potions I prescribe may not be perfectly sound, exactly right, but I will watch over time and learn if they, flawed though they be, at least helped.
Language lives and evolves, and “insane” has, in youthful usage, become synonymous with extreme, exciting, and “I wouldn’t try that myself.” In essence the behaviour being described as “insane” has failed the empathy test and perhaps the logic test but might still be admirable, even heroic. “Sane” on the other hand, in youth speak, can denote something rather dreary and common place.
While sane and insane are words, today, avoided by psychiatrists (formally at least), these words do have a place and definition in law.
Actually the supreme court of the USA just passed a judgement that allows the state of Kansas the right to continue rejecting the concept of “Not guilty by reason of insanity”. Kansas along with Utah, Idaho, Vermont and Montana do not allow this in their criminal codes. It is allowed in all other US States plus the UK, Canada, Australia, Hong Kong, India, Ireland, New Zealand and Norway.
Our culture has assumed for centuries, that for one to be culpable or guilty of a crime committed, a bad act, one must have a “guilty mind”.
The first time this was codified was at the M’Naughten trial in mid 1800’s.
The findings at this trial are the foundation for the Not Guilty by Reason of Insanity judgment for the succeeding 150 years. At the time, and still considered in court today, are two underlying questions to determine insanity, or at least, not guilty by reason of insanity. They are, in simple language:
Did the accused have the capacity to know right from wrong?
Did the accused have the capacity to appreciate the nature and consequence of his actions?
Sanity is the default position, assumed, with insanity having to be proved or argued convincingly.
Though guilt in our culture (and law) has always implied a “guilty mind”, a moral component, in common and careless usage it can simply mean “he done it”.
Canada, to bypass this common confusion, changed the “not guilty by reason of insanity” clause to a finding of “Guilty but Not Criminally Responsible due to mental illness”, (NCR) using the same underlying concepts.
The American Supreme Court decision is significant, not just for those before the court, but because it undermines a legal and formal acceptance of the idea that we should not be held responsible/punished for some behaviours that are beyond our conscious will and driven by brain illness/disease/defect. At the time of M’naughten, this was a mid 19th century shift away from judgements of human behaviour based on notions of goodness/evil/free will/possession/invitation to the devil/moral failure…