Automatic behaviour

Automatic behaviour or an automatism is a term used by doctors and lawyers, yet defined with agreement neither within nor between the respective professions. It would be only of clinical interest were it not for the fact that an automatism can, in certain circumstances, provide a complete defence to a criminal charge. The distinction in English law between insane automatism and automatism simp/iciter has no clinical basis and is driven by public protection considerations. The discussion that follows is of the clinical aspects. We need to recognize that we are struggling to put into medical language the philosophical concept of a body acting independently of the mind. FenwickA.5.4) an authority, considers that the following characterize automatic behaviour:

• involuntary, subject has no control over it

• inappropriate to the circumstances, lacking in judgement, out of character

• may be complex, purposeful, co-ordinated, and directed

• afterwards no recollection, or partial and confused memory

• if organic, there must be corresponding disturbance of brain function

• if psychogenic, behaviour is appropriate to the psychopathology

• there is a clear sensorium but complete or severe amnesia.

Organic automatisms

Organic automatisms may occur in association with epilepsy, the effects of alcohol or drugs (e.g. episodic dyscontrol syndrome), hypoglycaemia, transient global amnesia, and during sleep. Discussion of these is beyond the scope of this chapter, but it cannot be overemphasized that the commission of a crime during an automatism is extremely rare, even though automatisms (usually of very brief duration) in some of the above conditions are not unusual. Therefore psychiatrists need to exercise caution in giving opinions when the defence of automatism is raised. Fenwick(!5.4) provides useful criteria for assessing crimes allegedly attributable to an ictal and to a sleep automatism.

In an ictal automatism:

• the patient should be known to suffer from epilepsy, and previously manifested similar automatisms

• the act should be out of keeping with the character and the circumstances

• no evidence of premeditation or concealment

• witnesses, if available, should describe a disorder of consciousness

• loss of memory for the event but not for events before it

• the diagnosis is made on clinical grounds.

Knowledge of sleep disorders is specialized and changing (see Chapterl4.!4.!, Chapterii4i.14.2, Chapte£..4JA3., Chapteriii4.i14.4, C.h§.p.t§r...4..14..5. and Chapter.4.14.6, ). Few clinicians, other than specialists, have sufficient clinical experience on which to base forensic testimony. Violence during sleep is, however, a recognized, albeit exceedingly rare, phenomenon; cases are described in sleep-walking (somnambulism) and in night terrors. More recently, violent behaviour during sleep has been described in rapid eye-movement sleep behaviour disorder, sleep apnoea, and in sleep drunkenness—the transitional period between sleep and complete wakefulnessA.55)

FenwickA54) cautions that in most cases of somnambulism and night terrors there is a family history of these disorders and that onset is in childhood or, at the latest, adolescence. Onset in adult life is suspicious. Sleep automatisms occur in slow-wave sleep normally within 2 hours of going to sleep. There is disorientation on awakening, with amnesia for the event. There may be trigger factors such as drugs, alcohol, fatigue, or stress. Sexual arousal during the act (accompanied by penile tumescence) is highly unlikely. There are no attempts at concealment and the usual pattern is to summon help on awakening. The act should normally be out of character.

Psychogenic automatisms

Hitherto psychogenic automatisms have not been greatly explored in British courts because they would have resulted in an insanity verdict and mandatory committal to hospital. That situation has to some extent changed with the introduction of the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991. It remains to be seen whether, for example, dissociative disorders will be put forward and accepted as grounds for psychogenic automatism.

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