MEDICO-LEGAL ASPECT

OF
DISTURBANCE OF MENTALITY

INSANITY AND MENTAL DEFFICIENCY

1. INSANITY
In the medical viewpoint a person is insane when he is suffering from mental derangement or confusion or a
condition which prevents a person from orienting himself. It is a prolonged departure of the individual from his
natural mental state arising from bodily disease.
The legal definition of insanity by which the court is guided is more of an intellectual and moral concept rather
than medical. It is a defect of the mind which renders a person incapable of entertaining a criminal intent. The law
further presumes every person to be sane and to possess a sufficient degree of reason to be responsible for his
act unless the contrary can be proven.
Note: The legal definition of insanity by which the court is guided is more of an intellectual and moral concept
rather than medical. It is a defect of the mind which renders a person incapable of entertaining a criminal intent.
The law further presumes every person to be sane and to possess a sufficient degree of reason to be responsible
for his act unless the contrary can be proven.
The term insanity is commonly used to be synonymous with lunacy, madness, unsoundness of mind, mental
derangement, mental disorder or mental aberration or alienation.

Legal Importance of the Determination:

1.In the Civil Code;
a. Insanity is a restriction on the capacity of a natural person to act
b. Insanity modifies or limits the capacity of a natural person to act
c. Insanity at the time of marriage of any or both parties is a ground for the annulment of marriage
d. A testator must be of sound mind at the time of execution of a will
e. A witness to a will must be of sound mind
f. Insanity of the testator is a ground for disallowance of a will
g. An insane cannot give consent to a contract
h. The guardian or the insane himself, if there is no parent or guardian shall be held liable for damages
due to his insanity.

2. In the Revised Penal Code:

a. Insanity exempts a person from criminal liability
b. A person who becomes insane after final sentence
- Suspension of the execution and service of the penalties in case of insanity

3. In the Rules of Court

a. A guardian on the person of the insane must be appointed
b. An insane cannot be a witness in court

Factors Having Positive Correlation with the Development of Mental

Disorder:
1. Heredity — This is the most frequent and history reveals mental illness manifested by ascendants.

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2. Incestuous marriage, blood incompatability of parents, maternal infection during the early stage of pregnancy.
3. Impaired vitality — Mental worry, grief, physical strain, unhygienic surroundings, infection, birth trauma may
predispose a person to mental disorder.
4. Poor moral training and breeding — Improper breeding and moral training according to the social status,
particularly on free will and self-control, undesirable association, etc.
5. Psychic factors — Emotional disturbance, such as love, hatred, passion, disappointment.
6. Physical factors:
a. Non-toxic — Exhaustion resulting from severe physical and mental strain, illness, cerebral hemorrhage, trauma
on the skull affecting the brain.
b. Toxic — This may be produced by excessive formation or deficient elimination of waste product of metabolism;
by microbic infection, or excessive use of certain drugs.

Some Manifestation of Mental Disorders:

The condition of insanity cannot be considered clinically by the manifestation of one sign or symptom, but it is
essential to appreciate the condition of the mind as a whole. Although certain behavior may be observed in certain
types of insanity, they may also be observed in the clinically non-insane.
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. A whistle sound may be considered a bomb
explosion.A normal person may also suffer from illusion but further investigation by oneself may prove
that his judgement is wrong.
(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.
(e) Tactde — False perception of touch, as feeling that a worm is creeping on the skin.
(f) Kinesthetic — False perception of movement.
(g) Hypnagogic — False sensory perception occurring midway between falling asleep and being
awake.
(h) Lilliputian — Perception of object as reduced in its size.
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) Dementia Paralytica(General Paralysis of the Insane) — Degeneration of physical, intellectual and
moral power leading to paralysis ("cirrhosis of the brain").

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 (c) Dementia Praecox (Schizophrenia) — Dementia of the adolescence and characterized by loss of
memory.
(d) Senile Dementia — Occurring in advanced age and characterized by loss of memory, with childish and
silly behavior and physical degeneration.
(e) Toxic Dementia — Characterized by weakness of mind or feeble cerebral activity resulting from
continuous administration or use of toxic chemicals.

(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. If he can correct his wrong belief by later experiences, by logic or
information from other sources, then such delusion is not a proof of insanity.
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.
(c) Delusion of Reference — One thinks that he is always the subject-matter of conversation, news, speech
or action although it is not a fact.
(d) Delusion of Self-accusation — A false belief to have committed a crime or hurt the feeling of others.
(e) Delusion of Infidelity — A false belief derived from pathological jealousy that one's lover is unfaithful
although she is chaste, and tries to assault her.
(f) Nihilistic Delusion — A false belief that there is no world, that one does not exist, and that his body is
dead. This condition may occur in involutional melancholia.
(g) Delusion of Poverty — A false belief that one is financially ruined and that he has no money, is starving,
sick or even dead.
(h) Delusion of Control — A false feeling that one is being controlled by other persons.
(i) Hypochondriacal Delusion — A false feeling that one is suffering from an incurable disease, some parts
of his body are not functioning, or that he is not physically capacitated to do a thing on account of the
disease.
(j) Delusion of Depression — patient experiences feelings of uneasiness, worthlessness and futility.
(k) Delusion of Negation — feeling that some parts of the body are missing.
(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 inspite 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.
Obsession is a condition of the mind bordering on sanity and insanity. It is sometimes associated with
some sort of fear and usually occurs in persons suffering from nervous exhaustion.

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 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. Delusion may be present, but it is usually fleeting in character. The
increased mental activity also finds expression in increased muscular activity; the patient is restless and
always occupied. His finer instincts are blunted; he becomes untidy with his clothing even to the extent
of indecency. He is impatient, irritable, antagonistic and violent if interfered with. He is sleepless but his
physical health is not greatly affected. (Forensic Medicine, Sydney Smith and Frederick Fiddes, 10th ed.,
p. 387).
(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. The alternative condition of mania and
melancholia is known as manic-depressive psychosis, hence called "folie circulaire." In between attacks of
mania and depression is a period of cessation of symptoms of psychosis known as lucid interval. Any
person who committed a criminal act during lucid interval is criminally liable.
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.
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.

Some 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.
(4) Dipsomania — An irresistible impulse to indulge in intoxication either in alcohol or drugs. Repeated
intoxication for a number of years with alcohol or drugs which is voluntary is not dipsomania. One having
power to refrain from the use of intoxicating liquor or drugs and who becomes intoxicated voluntarily is
not a dipsomaniac (Black's Law Dictionary by H. C. Black, 3rd ed., p. 933).

(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 (Com. v. Sayre, 5 Wkly Notes Cas (Pa) 452).
(6) Sex Impulse — This includes all irresistible acts of sexual perversion.
(7) Suicidal Impulse — A strong desire to terminate one's life. This impulse may be present in acute
depression.

Steps in the Diagnostic Procedure of Mental Affection:

1. Anamnesis:

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 a. Family History:
(1) Inquire on the medical condition of the parents and other ascendants, uncles, brothers, and sisters.
(2) Inquire whether anyone of them suffered from nervous diseases, cerebral affection, suicide, syphilis,
etc.

b. Personal History:
(1) Detailed characteristic from childhood to his present state.
(2) Determine excess use of intoxicating drugs.
(3) Sexual life, occupation, mental strain, head injury and early nervous affection.

c. Information from relatives, friends and neighbors:

Change of conduct and behavior, habit, previous conduct or maniacal episode.

2. Physical Examination.
3. Instrumentations:
X-ray, electroencephalogram, scanning and other modern apparatus.

4. Mental Examination:
Psychologic Testing
Psychiatric Evaluation
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:

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).

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The accused was suffering from malignant malaria when she attacked, wounded and killed her husband. It has
been shown that malaria affected the nervous system and caused complications like acute melancholia and
insanity at times. The accused was considered not criminally liable (People v. Lucena, 69 Phil. 350).

2. As a Mitigating Circumstance:

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).

Rules Utilized By Courts to Determine Whether The Mental Condition Of An Accused Exempts Him From His
Criminal Liability:
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. The rule has been applied in England (Arnold
case, 1724) and in the United States (State v. Pike, 49 N.H. 399), but was 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

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(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.
An accused was held to be suffering from the disease of the mind when he attacked a person during a temporary
loss of consciousness caused by congestion of the brain due to arteriosclerosis (Bratty v. Atty. Gen. of Northern
Ireland, 1963).

A person who is suffering from malignant malaria when she killed her husband was held not criminally
liable because of insanity due to disease of the mind (People v. Lacena, 69 Phil. 330).

(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
reponsible. The accused's delusion that the killing in question has been directed by God was not sufficient to
excuse him in view of the showing that he knew it was against the law (McElroy v. State, 146 Tenn. 422).

One who commits bigamy under the delusion that the act has been directed by a vision from God was
held to be responsible when he admitted he knew at the time that the act was punishable by law of the State
(People v. Schmidt, 216 N. Y. 324).

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.

e. American Law Institute Rule:

In 1955, The American Law Institute with the support of the American Bar Association, formulated the following
rule of criminal responsibility:

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(1) A person is not responsible for his criminal conduct if at the time of such conduct as a result of mental disease
or defect he lacks essential capacity to appreciate the criminality of his conduct or to conform his conduct to the
requirements of the law;
(2) TVie term "mental disease or defect" does not include an abnormality manifested only by repeated criminal
or otherwise anti-social conduct.

The assassination attempt by Hinkley to President Ronald Reagan of the United States wherein the court
considered Hinkley to be insane has caused the development of a strong public opinion of re-examination or
restructuring of our law on defense of insanity. There is now a strong public opinion not to consider insanity as an
exempting circumstance to criminal liability. The following proposition are suggestedfor future action:
(1) An accused may be pronounced to be mentally ill. He can be treated in a mental hospital until recovery. After
recovery he may then be transferred to prison to serve cut the remaining term.
(2) The accused may be pronounced guilty with diminished responsibility. His mental condition may be considered
only as a mitigating circumstance to his criminal liability. Or he may be convicted if found insane for a lesser
offense because of emotional disturbance.

II. MENTAL DEFICIENCY

Mental deficiency (mental subnormality, mental retardation) is the below-normal intellectual functioning which
originates from the arrest or incomplete development of the mind during the development period below the age
of 18 which may be induced by various factors associated with the impairment of learning, social adjustment or
maturation.

Classical Classification:
1 Idiot - Usually congenital and due to defective development of the mental faculties. An idiot is wanting in
memory, will power and emotion. He cannot express himself by language, is quiet, timid and easily irritated. He
cannot guard himself against common physical dangers. The deficiency is usually associated with physical
abnormalities like microcephaly and mongolism. Mentality never exceeds that of a normal child over 2 years old.
The I.Q. is between 0 — 20.

2. Imbecile — Although the mental defect is not as severe as that of idiots, he cannot manage his own affairs. He
may be able to speak but with poor command of the language. He can easily be aroused
to passion and may show purposeful behavior. He may be trained to do simple work under supervision. The mental
age may be compared to a normal child from 2 to 7 years old and the I.Q. is 20 - 40.

3. Feeble-minded — Person whose mental defect, although not amounting to imbecility, is pronounced such that
he requires care, supervision, and control for his protection and for the protection of others. He is incapable of
receiving proper benefit from instructions in ordinary school. He lacks initiative and ability for any work or
responsibility. He has a mentality similar to that of a normal child between 7 to 12 years old and an I. Q. of 40-70.

Moron — A feeble-minded person of considerably higher intelligence as that of an imbecile but his intellectual
faculties and judgment are not as well developed as in a normal individual. He can carry routine duties in civilized
society as long as the demands made upon his mental capacity is not too discretionary. He is amenable to the
customs of the community and may not present so much of a social problem.

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4. Moral Defective — In addition to the mental defect, there are strong vicious and criminal propensities, so that
the person requires care, supervision and control for the protection of others. He is devoid of moral sense and
often shows intellectual deficiency, though he may be mentally alert. He is careless; pleasure loving; and a devil-
may-care sort of young man or woman who adheres to the principles of "live today for tomorrow we die", "live
fast and die young" and "it is only happiness that counts". (A Sypnosis of Forensic Medicine & Toxicology by C.
Thomas, 2nd ed., p. 125). Because of the stigma that may likely be attached to the child if the classical classification
(idiot, imbecile, feeble-minded) is used,
new classifications have been adopted by some countries.

Mental retardation is classified as follows:

1. Profound — I.Q. is under 20, and capable at most to limited self-help. There is most likely a need for
hospitalization or some type of environment in which care is available throughout his life-time.
2. Severe — I.Q. is between 20 and 35 and capable of habit training as a child. As an adult he is likely in need of a
controlled environment.
3. Moderate — I.Q. is 36 to 51 and can develop academic skill equal to about the second grade level. As an adult
he will most probably need a sheltered environment.
4. Mild — I.Q. is 52 — 67 and constitutes the greatest group of mentally retarded. He can develop academic skill
to about the sixth grade level. As an adult he can develop social and vocational skills. Whether he is to be
institutionalized or not depends more on his social skill and on the range of alternatives available to him than on
his intellectual functioning. Although it is not a part of the original standard classification, a fifth degree known as
borderline retardation with an I.Q. of 68 — 83 may be added.

In England, under the Mental Health Act 1959, Part I, No. 4, mental
deficiency is simply classified as:
1. Severe Abnormality — A state of arrested or incomplete development of mind which includes abnormality of
intelligence and is of such a nature or degree that the patient is incapable of living an
independent life or of guarding himself against serious exploitation, or will be incapable when of an age to do.
2. Subnormality — A state of arrested or incomplete development of mind (not amounting to severe abnormality)
which includes subnormality of intelligence and is of a nature or degree v/hich requires or is susceptible to medical
treatment or other special care or training of the patient.

Methods of Estimating Mental Capacity:

1. Intelligence Tests:
At the age of 18 the human mind is presumed to have attained its full development. Knowledge acquired after
such age comes from experience, memory and study. Intelligence testing may be used to

(a) diagnose the degree of mental retardation,

(b) study the ways in which the individual's intellectual ability is threatened by personality problems, and
(c) as a means to understand personality dimensions. There are many different tests used by psychometrists and
it is sufficient to mention some of them.

a. Performance Tests (Don't Require the Use of Language):

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(1) Good Enough Draw-a-person Test — A subject is asked to draw a person and a number of corresponding points
are given to different parts of the body and clothings. The total number of points is then converted into a
quantitative measure of intelligence. The test can provide evidence for personality functioning and conflicts as
well as intelligence estimate.

(2) Raven Progressive Matrices Test: — A series of designs in which a part is removed from each member of the
series, and the individual is presented with six alternative parts from which to choose the part which is missing in
the original design. This test is useful in measuring the person's ability to reason by analogy, for comparison and
to indicate the logical method of thinking.

b. Verbal Test — This depends essentially on words and numbers.

c. Mixed (Verbal and Non-verbal) Test:

(1) Binet Test — The individual is given credits in months for task completed successfully, and the individual's total
score is the sum of the months of credit received for items passed. The total credit in months (mental age) in
conjunction with the individual's chronological age is converted into an
intelligence quotient ( I . Q . ) . The test is valuable for children under 10 years old.

Example: If a person at the age of 20 was able to answer all the questions up to the age of 12, 2 in 8, 1 in 9 and 1
in 10 and each of the answers is equivalent to 2 months, then the person has an intelligence or mental age of 12
years and 8 months.

(2) Wechsler Tests — (Wechsler Intelligence Scale for Children — Revised, WISC-R, and Wechsler Adult Intelligence
Scale, WAIS): This consists of 12 subtests (six verbal and six non-verbal). The verbal test may consist of information,
general comprehension, similarities and vocabulary. The performance test includes a variety of scales, like
pictures, arrangements, block design, etc. The row for each subtest is converted to an equivalent weight score
permitting comparison with other subtests. When the different weighed scores are added together, the clinician
can obtain three different intelligence quotients: verbal, performance and full scale.

2. Intelligence Quotient (I.Q.):

Several test types are prepared corresponding to every age in months and these are answered by the person
examined. The age of the person examined is determined in terms of months.
The number of months corresponding to the test type answered divided by the age of the person in months is the
intelligence quotient (I.Q.)-
Example: A child at the age of 8 years and 4 months was able to answer the test for 7 years and 6 months. 8 years
and 4 months is equivalent to 100 months, while 7 years and 6 months is equivalent to 90 months. 90 divided by
100 equals 90 as I.Q.

I. Q. Classification
Above 140 "Near" genius or genius
1 2 0 - 140 Very superior intelligence
1 1 0 - 120 Superior intelligence
90 - 110 Normal or average intelligence
80 - 90 Dullness, rarely classified as feeble-minded

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7 0 - 80 Borderline deficiency, sometimes classified as dullness, often as feeble-minded Below 70 Definitely feeble-
minded

Principal Drawbacks to Different Intelligence Tests:

1. The tests seem to give undue weight to memory.
2. The tests do not take into consideration the vision or hearing of the subject.
3. The tests overlooked the fact that some persons are inattentive or nervous.
4. Cooperation of the person tested is absolutely necessary.

Mental Deficiency and Criminal Responsibility:

Imbecility, according to Article 12, par. 1 of the Revised Penal Code, is an exempting circumstance to criminal
liability. Inferentially the condition of idiocy is also an exempting circumstance inasmuch
as it is of a much more deficient degree as compared to imbecility. Feeble-mindedness is a mitigating circumstance
provided in Article 13 par. 8, 9 or even 10 of the Revised Penal Code.

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 some 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 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 feeble-minded warrants the findings in his favor of the mitigating circumstance provided for
in either par. 8 or 9 of Art. 13 of the Revised Penal Code, namely, that the accused is "suffering from some physical
defect which thus restricts his means of action, defense or communication with his fellow beings" or "such illness
as would diminish the exercise of his willpower" (People v. Formigones, 48 O.G. 1772).

How the Court Becomes Aware of the Mental Condition of a Person:

1. Any party in a proceeding may present evidences to show the mental condition of a person. He who alleges
something must prove the same by presentation of evidence in support of his allegation.
In a criminal proceeding wherein the defense of insanity is invoked, the party must present proofs that the accused
is insane and does not know the nature and quality of his act. In the probate of a will, the petitioner must present
evidence to show that the testator is of a sound and disposing mind at the time of execution of a will.

2. Upon motion of one of the parties, the court may issue an order to submit a person to a physical and mental
examination.
Rule 28, Rules of Court:
Physical and mental examination of person:
Sec. 1. When examination may be ordered — In an action in which the mental or physical condition of a party is
in controversy, the court in which the action is pending may in its discretion order him to submit to a physical and
mental examination by a physician.

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Sec. 2. Order for Examination — The order for examination may be made only on motion for good cause shown
and upon notice to the party to be examined and to all other parties, and shall specify the time, place, manner,
conditions and scope of the examination and the person or persons by whom it is to be made.
Sec. 3. Report of findings — If requested by the person examined, the party causing the examination to be made
shall deliver to him a copy of a detailed written report of the examining physician setting out his findings and
conclusions. After such request and delivery the party causing the examination to be made shall be entitled upon
request to receive from the party examined a like report of any examination, previously or thereafter made, of
the same mental and physical condition. If the party examined
refuses to deliver such report the court on motion and notice may make an order requiring delivery on such terms
as are just, and if a physician fails or refuses to make such a report the court may exclude his testimony if offered
at the trial.

Ways of Hospitalizing an Insane Person:

1. Judicial Method:
a. Upon petition by the Director of Health.
b. The court upon knowledge that the imbecile or insane committed a felony.
2. Extra-judicial method:
a. Voluntary.
b. Involuntary.

1. Judicial Methods:
a. Rule 101, Rules of Court:
Proceedings for hospitalization of insane persons:
Section 1. Venue. Petition for commitment — A petition for the commitment of a person to a hospital or other
place for the insane may be filed with the Court of First Instance (Regional Trial Court) of the province where the
person alleged to be insane is found. The petition shall be filed by the Director of
Health in all cases where, in his opinion, such commitment is for the public welfare, or for the welfare of said
person who, in his judgement, is insane, and such person or the one having charge of him is opposed to his being
taken to a hospital or other place for the insane.

Section 2. Order for hearing — If the petition filed is sufficient in form and substance, the court, by an order
reciting the purpose of the petition, shall fix a date for the hearing thereof, and copy of such order shall be served
on the person alleged to be insane, and to the one having charge of him, or on such of his relatives residing in the
province or city as the judge may deem proper. The court shall furthermore order the sheriff to produce the
alleged insane person, if possible, on the date of the hearing.

Section 3. Hearing and judgment — Upon satisfactory proof, in open court on the date fixed in the order, that the
commitment applied for is for public welfare or for the welfare of the insane person, and that his relatives are
unable for any reason to take proper custody and care of him, the court shall order his commitment to such
hospital or other place for the insane as may be recommended by the Director of Health. The court shall make
proper provisions for the custody of property or money belonging to the insane until a guardian be properly
appointed.

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Section 4. Discharge of insane — When, in the opinion of the Director of Health, the person ordered to be
committed to a hospital or other place for the insane is temporarily or permanently cured, or may be released
without danger he may file the proper petition with the Court of First Instance (Regional Trial Court) which ordered
the commitment.

Section 5. Assistance of fiscal in the proceeding — It shall be the duty of the provincial fiscal or in the City of Manila
the fiscal of the city, to prepare the petition for the Director of Health, and represent him in court in all proceedings
arising under the provisions of this rule.

2. The court may order confinement of insane or imbecile upon knowledge that he has committed^ felony:
Art. 12, Par. 2, Revised Penal Code:
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 permission of the same court.

2. Extrajudicial Methods:
a. Voluntary:
The insane person himself or with the assistance of the relatives or guardian during the lucid intervals or during
such time that he is still normal may request his confinement in a hospital or asylum. This is common among
persons who are afflicted with the disease and are aware of the advantage of hospitalization.

b. Involuntary:
The immediate relatives, the peace officer or other persons who are concerned with the welfare of the society
may force the insane to be confined in a hospital. Such coersive confinement may be in accordance with the valid
exercise of police power of the state or by virtue of ordinance.

Police power is the power inherent in a government to enact laws within constitutional limitations, to promote
order, safety, health, morals, and the general welfare of society.

Sec. 2238, Revised Administrative Code — General power of council to enact ordinances and make regulations:
—"The municipal council shall enact such ordinance and make such regulations, not repugnant to law, as may be
necessary to carry into effect and discharge the powers and duties conferred upon it by law and such as shall seem
necessary and proper to provide for the health and safety, promote the prosperity, improve the morals, peace,
good order, comfort and convenience of the municipality and the inhabitants thereof, and for the protection of
property therein".

III. MALINGERING
Malingering is the feigning or simulation of a disease or injury characterized by ostentation, exaggeration and
inconsistency.

Causes of Malingering:
1. To Avoid Military or Naval Training:
2. To Avoid Court Summons:
3. As a Defense to a Criminal Prosecution:

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4. To Increase Civil Liability:
5. To Promulgate Sympathy:

Types of Malingering:
1. "Feigned or Fictitious" Malingering:
Malingering is built up out of pure imagination and does not have the slight basis of fact. The disease or injury
which a person allegedly is suffering from does not exist at all.
Example: A person may simulate that he is totally blind while in fact both eyes are normal.
2. "Factitious" Malingering:
This is a form of malingering whereby something really exists as a fact but is converted to a more serious disability
or injury, or to an exaggeration of the real complaint. Here the person is really suffering from an injury or disease
but he may exaggerate or amplify the seriousness of the complaint or nature of the injury or disease.
Example: A person might have received a small superficial scratch but complained of severe and unbearable pain
and incapacity to move.

Points which Make a Physician Suspect that a Person is Malingering:

1. Presence of a Cause for the Subject to Malinger:
A person may feign disease or injury because he wants to avoid something, like military training, court trial or
other obligations which he does not like, or he wants to get something, like sympathy or greater civil damages.
2. Inconsistency Between the Injuries or Disease Suffered from and the Symptoms or Disability Manifested:
In factitious malingering the subject may show certain manifestations which, in the ordinary course of life, are
inconsistent or not proportionate to the actual physical disability present.
3. Symptoms Not Supported with Organic Lesion:
A woman may allege that she has been abused by force and that she bied profusely, but on physical examination
a few hours after the alleged assault, no sign of physical injury was noticed on her private organ.
4. Abrupt Onset of Symptoms:
If a person feigns insanity or some other diseases, he may manifest abrupt symptoms which are incompatible with
the normal course of disease.
5. Refusal to be Subjected to Painful or Annoying Treatment:
A person may feign that he is suffering from sprain or fracture of his upper or lower extremities. The physician
may suggest the placing of the injured portion under plaster cast and the patient may refuse because it may put
him to some inconvenience. A person may complain of some disturbance in the gastrointestinal tract but when
prescribed magnesium sulfate, he refused to take it. Whenever a physician is requested to examine a patient to
determine whether he is malingering or not, he must utilize all
of his senses, have a keen observation and apply methods of detection appropriate for the occasion.

Ways to Determine Malingering:

There is no specific test for a specific form of malingering. The test applicable depends upon the demand of the
occasion considering the attitude of the subject and the nature of the malingering.
The tests may be:
1. General Procedure — The method is applicable to all forms of malingering:
a. Observation of the subject during his unguarded moments:
A person cannot always be conscious that somebody is observing him. He may for some moments unconsciously
show his normal condition and not exhibit the disability feigned.

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b. Complete history and physical examination:
The history that may be narrated by the subject may not be compatible with the result of the physical examination
and the manifesting symptoms are common among malingerers.
c. Application of general anesthesia.
d. Application of sudden unexpected minimal amount of electrical stimulus.

2. Specific Procedure:
a. Feigning Blindness:
(1) Place a convex 12D lens before the "good" eye and a weak concave lens (say 0.25D) before the "blind" eye and
ask the patient to read Snellen's test types from a distance of 6 meters. If he succeeds in reading it is a definite
proof that he is malingering, since it is impossible to read the type through such convex lens.
(2) Place a lighted candle at a distance of 6 meters from the patient, and a prism with base upwards or downwards,
before the good eye. If the patient can see two flames it means that good vision is present on both eyes.
(3) Take a firearm and with the patient focusing his eyes towards the revolver, fire three or four shots in the air.
Then all of a sudden aim the firearm towards him. If the patient is blind there will be no instinctive act of dodging.
b. Feigning Deafness:
(1) This is a method to determine whether only one of the ears is allegedly deaf. Place a loud tickling watch in the
supposed sound ear and ask if he is able to hear the tickling. If he answers in the affirmative, gradually withdraw
the watch and ask him when he can no longer hear the tick. Place the watch on the "deaf" ear and ask him if he
hears the tick. He will certainly give a negative answer. Now let him close both eyes and you place something
metallic (which will make him believe it to be a watch) against the back of the deaf ear, at the same time hold the
watch behind (but not touching) the sound ear and ask
him if he is able to hear the tick. If he says no, then he is malingering.
(2) Close the sound ear with cotton. Make a loud noise on the "deaf" ear. Notice the expression of the face.
c. Feigning Insanity:
There is no specific test or procedure to determine feigning insanity. A keen observation of the behavior
coupled with the history and physical findings probably are the most reliable.

IV. OTHER CONDITIONS MANIFESTING OR SIMULATING DISTURBANCE OF MENTALITY

1. Somnambulism:
This is an abnormal mental condition whereby a person is performing an act while in the state of natural
sleep. A somnambulist might be concentrated in a particular train of idea or obsessed by certain thoughts which
baffled his mind that he tried to execute it while in the state of sleep. He may commit the crime
of murder, infanticide, or parricide while under the influence of the fit. A somnambulist has no recollection of the
events occurring during the fit and in several courts of different countries somnambulists are exempted from
criminal liability.
In a case cited by Modi, Marggie Alexander was charged of having killed her child with a razor while in the
state of sleep. The jury gave a verdict of guilt but insane because the somnambulist did not know what she was
doing nor was capable of appreciating the nature and quality of the act.

In the Philippines, in the case of People v. Gimena (55 Phil- 604) the defendant attacked his wife with a bolo. The
defense was that he was in the state of somnambulism when he attacked his wife. The court held that the offense
charged was committed by the accused while in the state of somnambulism. Somnambulism is recognized by the

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court as an exempting circumstance as a manifestation of insanity. Here the defendant was placed under
observation for sometime but it was not shown that he was suffering from somnambulism.

2. Semisomnolence or Somnolencia:
A person is in a semisomnolence state when he is half asleep or in a condition between sleep and waking.
A person may be suddenly aroused and may unconsciously commit a criminal act, like murder, infanticide or
parricide, or some other crimes, while his mind is at the state of confusion. Criminal acts committed in this state
do not show manifestations to justify insanity. There is no jurisprudence in the Philippines deciding squarely
whether it will exempt a person from criminal liability.

3. Hypnotism or Mesmerism:
A person is made unconscious by the suggestive influence of the hypnotist. He may commit a criminal act
while under the influence of hypnotism which he may not be capable of doing while under a normal state.A person
cannot be hypnotized against his will, and if a person volunteers to be hypnotized he must anticipate all the
consequences of his acts while under the hypnotic spell. Hypnotism as a defense to a criminal act is not accepted
with favor in the court. A person cannot take advantage of his own misconduct. However, under the Civil Code
(Art. 1328) contracts agreed to during hypnotic spells are voidable. The Civil Code seems to acknowledge the
absence of the normal state of mind of a person under the influence of hypnotism.
4. Delirium:
Delirium is a state of confusion of the mind. It is characterized by incoherent speech, hallucination,
illusions, delusions, restlessness, and apparently purposeless motions. A person may, when under the state of
delirium, commit a crime. It may be advanced that a person committing a felonious act while in a delirious state
may be exempted from criminal liability although there is no jurisprudence in the issue yet.

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