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Century Crisis Over the Adjudication of Wills

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Century Crisis Over the Adjudication of Wills The Origins of Forensic Psychiatry in the United States and the Great Nineteenth- Century Crisis over the Adjudication of Wills James C. Mohr Forensic psychiatry emerged as a professional activity in the United States during the first third of the nineteenth century when four major factors coalesced: the medicolegal vision of early American physicians, the introduction of new theories about insanity, the concern of early state governments with mental health, and the advent of marketplace professionalism. From the outset, forensic psychiatry found itself involved in the adjudication of wills. The evidence suggests that postmortem diagnoses of insanity were employed through the middle decades of the nineteenth century to maintain stable and predictable patterns of property conveyance in the new republic. But such diagnoses then became something of a fad, a way to raid estates. Courts and legislatures reacted against that trend during the last decades of the nineteenth century, when fundamental social stability was no longer an issue, in order to protect individual testators and limit the power of forensic psychiatry. By the early decades of the twentieth century, patterns had emerged that have since been taken as normative. When the American Republic was England and to establish instead a merit- founded in the last decades of the eigh- based system of genuine service to the teenth century, the future role of profes- people as a whole. Many of the most sionals in American society was far from prominent physicians and attorneys in the fixed. But doctors and lawyers were op- new United States of America also be- timistic. Many of them regarded the Rev- lieved that the future of both their profes- olution as a chance to throw off the thor- sions lay in cooperating with one another oughly corrupted and largely class-based and with the state. Indeed, medical juris- guilds that passed for professionalism in prudence, conceived of as a separate pro- fessional undertaking, was thought to Dr. Mohr is professor of history at the University of have a nearly utopian future.' Benjamin Oregon. Address correspondence to: Dr. James C. Mohr, Rush, a signer of the Declaration of In- Dept. of History, University of Oregon, Eugene, OR 97403-1288. dependence, a confidante of Thomas Jef- J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 273 Mohr ferson, and the nation's best-known med- the nineteenth century by a host of new ical professor, spoke for many physicians theories regarding mental illnesses and and attorneys at the beginning of the nine- how to treat them. Emanating principally teenth century when he hailed the pursuit from France (in an era when French ideas of medical jurisprudence: "Fraud and vi- were welcomed by America's anti-En- olence may be detected and punished; glish professionals and intellectuals). unmerited infamy and death may be pre- these new theories and new therapies vented; the widow and the orphan may be were eagerly embraced by the optimistic saved from ruin; virgin purity and inno- Americans, and pushed to further ex- cence may be vindicated; conjugal har- tremes in the United States. Collectively, mony and happiness may be restored; un- these new theories had the effect of intro- just and oppressive demands upon the ducing a large number of gradations and services of your fellow citizens may be variations of sanity (or of insanity) to obviated: and the sources of public mis- replace older, sharper distinctions be- ery in epidemic diseases may be re- tween persons clearly deranged, on the m~ved."~That was a powerful prescrip- one hand, and persons who were merely tion. As his prime example of the way quirky or less competent or temporarily legal medicine could help society, Rush "visited by God" or simply troubled, on went on to discuss the subject of insanity, the other hand. The more gradations and a subject upon which he had himself pub- variations physicians looked for, the more lished important work. they found; and physicians were becom- Mental illness was at that time much ing convinced that the many new types closer to mainstream medicine than it has and degrees of insanity they were identi- since become; and mental illness, in con- fying were far more prevalent among the trast to most of the other areas of general general population than people had pre- medicine, seemed at the outset of the viously recognized. They were also be- nineteenth century amenable to treatment. coming convinced that they could do Physicians understood all too well that something about those mental ail- they were not making much headway ment~.~-' against conventional or physiologic dis- The new American Republic was the ease: and they would continue to founder first large-scale society for more than a on those fronts until the discovery much thousand years to be based upon the in- later in the century of bacterial agents for formed consent of the citizenry. For that some of those diseases. But many physi- reason the United States appeared to con- cians, like Rush, felt confident of some temporaries to be a genuinely revolution- success, even real progress, in the realms ary experiment, far more tentative and of mental health. They knew more about problematic in the monarchical world of human behavior, after all, than they did the early nineteenth century than it now about the internal workings of the human appears to be from the vantage point of body, and importantly, they were excited the late twentieth century. It followed and encouraged in the early decades of from that revolutionary premise that the 274 J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 Forensic Psychiatry and Adjudication of Wills mental stability of the citizenry was cru- tury, when government begrudgingly ac- cially important to the ultimate well- cepted and applied some of the early les- being of the state. Consequently, attention sons of bacteriology. In that view, recent to mental health was not simply charity or large-scale commitments to public health humanitarianism; nor was it the exclusive have been seen as innovative. even some- hobby-horse of an aggressive medical how vaguely un-American, develop- profession looking to expand its turf. At- ments; but such notions reflect a pro- tention to mental health was also a polit- foundly ahistorical view of public health. ical and social imperative in the new Re- Only governmental attention to the bac- public. terial diseases fits that model; and even With this in mind, it comes as no sur- for the case of the bacterial diseases. co- prise to find nineteenth-century American incidence may be as salient as policy: states interested in the issue of sanity and physicians discovered some useful things ready to work with physicians in the bur- for the government to do in the areas of geoning and rapidly transforming area of bacterial medicine at about the same time mental health. The institutional embodi- the state began to take on its modern ment of this optimistic interaction centralized and bureaucratic characteris- emerged in the form of the public asylum. tics. With government help, every citizen who If mental health is included in the def- needed mental attention might enjoy the inition of public health, an inclusion apparently beneficial therapies associated which nineteenth-century Americans earlier with private retreats3, Most mod- would have taken for granted, then the ern Americans would be surprised at the tradition of state support for public magnitude of these undertakings. Mental health, complete with the outlay of major asylums were among the greatest public resources, has strong and deep roots in works of the nineteenth century. Ordinary the United States. The case of Oregon citizens were immensely proud of them provides a good example. Between the and never failed to take visitors, espe- Civil War and 1900, successive Oregon cially foreign visitors, to see them. The state governments spent roughly one- construction and maintenance of what third of their total outlay for the entire they called lunatic asylums consumed period on mental health (most of it build- huge amounts of public money from the ing and maintaining patients in the state's 1820s in the older Eastern states right asylums). That figure would almost cer- through the end of the century in the tainly astonish citizens today and would newer Western states. probably surprise most historians: about There is a mistaken notion in the his- one-third of all the money the state gov- tory of American public health that the ernment spent for that entire period on all United States did little or nothing-cer- fronts- economic development, educa- tainly little or nothing of any real val- tion, the state militia, everything-went ue-in the general field of public health to public mental health.' In short, by until the beginning of the twentieth cen- looking at state governments. where the J Am Acad Psychiatry Law, Vol. 25, No. 3, 1997 275 Mohr real action took place during the nine- and states made a virtue of opening the teenth century in any event, rather than professions to all and any practitioners the national government. and by includ- who could persuade fellow citizens to ing mental health in the definition of pub- employ their services. By 1840, the entire lic health, it is possible to see clearly that United States had become a land where the United States-in sharp contrast to each profession had to shift for itself, and conventional assumptions-has a power- so did every professional. '-I4 Indeed, ful and extended tradition of governmen- this era ushered in America's unique ver- tal spending on public health. sion of "marketplace professional- Given the prominent place of public ism"-a pattern quite different from pro- concern over and large-scale state com- fessional development elsewhere-along mitment to matters of mental health, it is with a number of its attendant features not difficult to predict that a host of new (including medical malpractice, the real legal issues would begin to arise in con- rise of which also dates from this peri- junction with the subject of insanity-and od).
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