Book Review: Mad- Doctors in the Dock: Defending the Diagnosis, 1760-1913 Reviewed by Linda Ledford-Miller

Joel Peter Eigen, Mad-Doctors in the Dock: Defending the Diagnosis, 1760-1913. (Johns Hopkins University Press, 2016. 
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This meticulously researched text is the third and final volume in a trilogy dedicated to the study of insanity trials. The first volume, Witnessing Insanity: Madness and Mad-Doctors in the English Court, was published by Yale University Press in 1995; the second, Unconscious Crime: Mental Absence and Criminal Responsibility in Victorian London, was published by Johns Hopkins in 2003. Mr. Eigen is the Charles A. Dana Professor of Sociology at Franklin and Marshall College in Pennsylvania and an honorary Principal fellow at the University of Melbourne. He has spent over thirty years engaged in research on the shifting definitions and courtroom use of insanity in British trials, and in preparation for his third book, he identified his true research question as : 'Where did these diagnoses come from in the first place?’ (ix). 

Mad-Doctors contains an introduction, seven chapters, and a thorough conclusion. The book investigates the roles of all the players in court cases: the judge, the jurors, the attorneys, the witnesses, the accused, medical practitioners, and forensic psychiatric witnesses. By now Eigen has examined nearly 1000 cases, but the focus here is particularly on 1876 to 1913, the shift from relying on the testimonies of friends and associates of the accused, the increased testimony of medical experts, and the emergence of a diagnosis of homicidal mania as an acceptable cause of sometimes despicable and otherwise illogical murderous acts.

After explaining his investigative method in the Introduction, in the first chapter Eigen gives an overview of insanity trials in the period, observing in multiple instances that verdicts of not guilty due to insanity  might lead to an acquittal and then a long internment in a mental institution . The second chapter provides the reader with relevant medical terminology used in trials: delusion, melancholia, mania—terms of broad meaning and broad application. Chapter three shifts attention to medical practitioners. Prison and police surgeons and alienists (the term for medical psychologists) had direct and often prolonged contact with the accused, and thus became increasingly more important in the courtroom, while the voice of the accused, friends and neighbors less important.

The following two chapters deal with courtroom diagnoses. Chapter 4 investigates delusion, the ‘most frequently invoked medico-legal term in medical testimony’ as lay observations of mental instability became much less regarded and the courtroom dominated by expert testimony (80). The fifth chapter examines how diagnoses were applied, resisted, and then defended, while further elaborating on how a particular diagnosis affected the actions of the accused and the accused’s understanding of those actions.

Chapter Six arrives at the true crux of the matter: the development of the diagnosis of homicidal mania, though the Preface presents a specific case of the diagnosis of homicidal mania where the mother drowned her newborn daughter in a pail of water ‘and fastened the lid ,’ but not before warming the water first in order not to be cruel (ix). It is in this chapter Eigen finally confronts his principal area of interest. Perhaps the explanations and research of previous chapters allow the reader to engage in this third volume with many connections developed more extensively in the first two volumes.  And of course, the question/diagnosis of delusion runs throughout the book, and is cited by many mad-doctors to support the diagnosis of homicidal mania.

The seventh chapter turns to the role of judges in insanity trials. They worked to determine the validity of medical evidence and its relation to the case at hand and to keep jurors focused on determining to what extent the accused was aware of what he or she had done.
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In the conclusion, Eigen examines the conditions, cultural and legal, that led to the rise of the forensic psychiatrist in courtroom testimony. Eigen calls the  psychiatrist ‘The most culturally informed of medical specialties’ and charts how the psychiatrist  became the new expert witness and homicidal mania the new expert diagnosis (178).

The book is exhaustively researched and contains extensive and thorough footnotes. There is no bibliography. Though well-written, the text is clearly for an academic audience rather than a popular one, and a specialized audience at that. For those interested in legal proceedings in the Old Bailey in London during this period and the history of medical testimony in those proceedings, this book answers the central question of the diagnosis of homicidal mania and hints at a number of areas for further research.
 
Bio: Linda Ledford-Miller is Professor of Spanish, Portuguese, and American Minority Literature at the University of Scranton, in Scranton, Pennsylvania.  She has degrees in English and American Literature from the University of California, Irvine, and in Luso-Brazilian literature and Comparative Literature from the University of Texas, Austin. She has published widely on travel writing and women writers. An avid reader of mysteries, she has shifted focus to crime fiction, working on Robert Downey Jr.’s interpretation of Sherlock Holmes, gender roles in the In Death series by the American J.D. Robb, the village mysteries of the Canadian Louise Penny, and the philosophical Inspector Espinosa series by the Brazilian Luis Alfredo Garcia-Roza.

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