[Reprint from the Alienist and Neurologist, April, 1882.] 
SIMULATION OF INSANITY BY THE INSANE^ 
By James G. Kiernan, M. D., Chicago, Ill. 
A MONG the questions of interest, from an alienistic 
standpoint, which have been brought up for examin- 
ation by the Guiteau trial, this question stands preeminent. 
If (a fact of which I believe most firmly there can be 
no question), there exists an abnormal mental condition 
in this criminal, and if he be regarded as a case of 
primary monomania, the primare verrucktheit of the Ger- 
mans, the manie raisonnante of the French, simulation is 
what might have been expected. Assuming this to be 
the case, his simulation is of rather a peculiar type. 
Insanity, as claimed by him, is different from the idea of 
insanity as held by alienists, and is simply a quasi-legal 
plea that( he was inspired by the Deity to remove the 
President; his free will was destroyed, and, according to 
him, a man without a free will is in the legal sense insane. 
To use his own phrase, he* is "Abraham mad but not 
crank mad." Strictly speaking, Guiteau did not feign 
insanity, but used a legal quibble. This plea was fatal to 
a belief in his insanity, already existent in the minds of the 
more intelligent laity, and had a very similar effect on a 
large number of the profession. 
Yet such a plea of insanity was a very natural one on 
the part of an insane lawyer, and as the subject becomes 
therefore of special interest, I have undertaken to exam- 
ine the cases of simulation of insanity by lunatics reported 
in the literature, supplementing them by three cases coming 
under my own observation. 
* Bead before the Chicago Medical Society, March 20, 1882. 2 
James G Kiernan. 
These cases, while not frequent, are not excessively 
rare. 
The Section on Mental Diseases of the International 
Medical Congress of 1876,* unanimously adopted the fol- 
lowing conclusion: "It is not only not impossible for the 
insane to simulate insanity for any purpose, in any but 
its gravest forms of profound general mental involvement, 
but they actually do simulate acts and forms of insanity, 
for which there exists no pathological warrant that we 
can discover in the real disease affecting them." 
Dr. Nichols,f of Bloomingdale Asylum, New York, at the 
conference of experts on the Guiteau case, cited the case 
of a man who committed murder under, as he believed, 
the command of the Virgin Mary, who appeared to him 
in the flame of a candle. Two young lawyers were 
assigned as his counsel; they .'advised him to feign 
insanity, which he did, under the form of dementia. 
The experts, Drs. Nichols and Ranney, detected both the 
sham and the real insanity, and had him sent to an 
asylum, where his insanity became unmistakable. Dr. Ray, 
in his discussion of the case of Trimbur,^ says: 
"The criminal classes to which most of these simu- 
lators belong know as well as any one else, that the plea 
of insanity is one of the dodges whereby people now 
escape the punishment of their crimes, and they may not 
forget to act accordingly when they are insane. Trimbur 
being unconscious of his real insanity, but with mind 
enough to understand his situation, and to remember what 
he had heard about insanity in connection with crime, 
concluded to make a show of being crazy." 
Dr. Workman|| cites the case of an insane man who 
had escaped from his asylum and killed his wife during 
an insane fit of jealousy; the man professed to the doctor 
to be completely amnesic while under trial for murder, 
denied that he had ever been under the doctor's charge 
or that he knew anything about the asylum. The doctor 
• Tr.'insacHons of the Congress, pp. xix , xx. 
f Chicago Medical Review, Vol JV.,p.544 
t American Journal of Insanity, October. 1874. 
|| C ited by Dr Hughes, liansactions of International Medical Congress of 1876, 
p. 1007. Simulation of Insanity by the Insane. 
3 
stated to the jury that the man was both simulating 
insanity and was insane. The prisoner was acquitted and 
sent to the Criminal Lunatic Asylum, at Kingston, Canada. 
The doctor saw him there two years subsequently. He 
then fully recognized the doctor, and, in answer to a 
question, said that " he did not want to know the doctor" 
when previously examined by him. Had he been sane 
he would, as Dr. Workman suggests, have known that 
sufficient proof of his past insanity could have been pro- 
duced, and he would have abstained from his clumsy 
simulation, or he would have acted more cleverly. 
Dr. John P. Gray* cites the case of a man who, two 
or three days before being admitted was met in the 
woods going toward his father's, carrying a gun, and 
said he was " going to shoot the old man." When 
admitted he said "he had been out of his head for quite 
a while; should think twenty-four hours." 
Dr. E. C. SpitzkaJ cites a case in which a criminal 
lunatic, having all the signs of degeneracy mentioned by 
Morel, feigned a type of insanity with religious delusions. 
The most systematic article that has, as yet, appeared 
in the United States on this subject, and which deserves 
particular mention as being the most original contribution 
to the subject of psychiatry at the Congress before which 
it was read, is that of Dr. C. H. Hughes.J He says: 
"The insane appear at times when they have an object 
to accomplish more crazy than, and different from, what 
they really are; this is the sense in which we use the 
term simulation, and this condition is akin to that of 
feigning by the sane. Simulation, while it presupposes 
a degree of sanity, does not require that the patient 
should be wholly sound in mind, and it might be attempted 
by a convalescent patient not thoroughly recovered, desir- 
ous of remaining longer in the hospital, or for some other 
cause." 
A case coming under his observation was as follows: 
R. S., aged 25, married, had a history of domestic 
* Report for 1876. p. 33 
t Journal of Nervous and Mental Disease, Vol. V., p. 163 
I Transactions of the International Medical Congress of 1876. p. 1110. James G. Kiernan. 
4 
difficulties, masturbation and three weeks insanity before 
admission. Entered the Missouri State Lunatic Asylum 
in April, 1867, and was discharged recovered November 
of the same year. He had been a member of a variety 
show before becoming insane. Soon after the onset of 
his insanity he had been seized with a sudden desire to 
preach, and, securing an audience in a country town, con- 
ducted the services with such an outrageous disregard of 
decency and propriety that he was driven from the pulpit. 
At the asylum to which he was sent soon after, he went 
through various insane performances, which were increased 
or diminished as there was evidence of lack of interest or 
the opposite among his auditors. 
Dr. Hughes, in another article,* cites the case of a 
lunatic who committed murder, and feigned to be more 
insane than he was. From certain indications it would 
appear that this condition would explain the psychologi- 
cal problem involved in the case of Hamlet. As Dr. 
Rayf suggests: 
" In this scene he adjures his friends if they see him 
bearing himself however strange or odd, 'as he might, 
perchance, think meet to put an antic disposition on/ 
never to let drop the slightest intimation of his design. 
This remark, on which the theory of Hamlet's insanity 
being feigned is mainly founded, indicates at most an 
indefinite half-formed resolve to accomplish a purpose by 
simulating a disease that was already overshadowing his 
spirit in all its fearful reality." 
I have myself elsewhere recorded J an instance in 
which a case of katatonia feigned one of the symptoms 
of that psychosis for a specified purpose. Laehr|| nar- 
rates the case of a person in whom there was marked 
hereditary taint, who committed a crime against morals, 
shammed a form of insanity which he had not, and his 
real insanity came out after the sham was exposed. 
Pelman,§ who has made an exhaustive study of the 
* American Journal of Insanity, October, 1874. 
t Mental Pathology, p 572. 
J Katatonia, Journal of Insanity, July, 1877. 
|| Archiv fur Psychiatric, Band. I. 
§ Irrtnfreund, No. X., 1874. Simulation of Insanity by the. Insane. 
5 
subject, cites many similar cases; as also do Ingels,* 
Stark f and Delasiauve.J 
My own three cases are as follows: 
L. L., aged 48, has had a brother and two uncles 
insane; was for a long time a pauper; is somewhat 
demented; has at times hallucinations of hearing; com- 
plains continually about having tar and grease in his 
head, and says he is insane in consequence. He says 
but little on these subjects except to the doctor, and for 
a long time refused to work as being insane and having 
tar and grease in his head. He has found that his state- 
ment of being insane and having tar and grease in his 
head draw attention of visitors toward him, and lead to 
his receiving tobacco; he is therefore markedly obtrusive 
with these statements when in presence of visitors. He 
denies that he has hallucinations, and these can be drawn 
from him only after prolonged questioning. The patient's 
skull is asymmetrical, and he is one of the cases hover- 
ing between primare verrucktheit of the Germans, imbe- 
cility and terminal dementia. The contrast between his 
concealment of his real insanity, and the obtrusive manner 
in which he manifests his assumed delusions is very 
marked. 
The second case was a case of hebephrenia (the 
pubescent insanity of Skae; the primary dementia of 
some asylum reports; one of the varieties of insanity of 
masturbation), who displayed all the self-importance and 
ideas of self-importance found in that psychosis, but who 
found that a case of monomania attracted much more 
attention than he did, simply because the latter claimed 
to have written several of Shakespeare's tragedies ; where- 
upon he claimed to have written "all of Byron, all of 
Shelley and all of Milton." A simple cross-examination 
showed this claim to be a feigned one, and this patient 
not infrequently so admitted to the physician, but kept up 
making the claim to visitors, although he refrained from 
so doing to the physicians themselves. 
I have seen one more case. A man who was a victim 
of chronic secondary mania, who plunged every morning 
into the river for a bath, breaking the ice if necessary to 
secure it. This man found that by feigning dementia he 
was able to secure tobacco and other little comforts, and 
* Zeitschrift fur Psychiatric. 1870. 
t Ibid., 1872 
t Journal de Medecine Mentale, 1868. 6 
James G. Kiernan. 
he therefore kept this up on occasion, relapsing into his 
usual condition when his end was attained. 
Dr. Spitzka* has noticed such tendencies among hebe- 
phreniacs frequently, both in the United States and in 
Europe. I also have called attention to these in another 
communication.f 
Taking the cases cited by Nichols, Ray, Workman, 
Hughes, Spitzka, Gray, Laehr, Delasiauve, Pelman, Ingels, 
Stark and myself, it would seem fair to conclude that- 
ist. The insane can, and do feign insanity for a 
purpose. 
2nd. That the types of insanity so doing are, as a 
rule, those in which there is a strong hereditary taint. 
There may be a slight degree of dementia, but this can 
not be extreme. 
3rd. The type of insanity most likely to simulate 
insanity is the primare verrucktheit of the German, the 
manie rai|/sonnante of the French, the imbecility of the 
first grade of Ray and Nichols, the monomania of Spitzka, 
the chronic intellectual mania, or chronic mania, without 
incoherence, of asylum reports. 
4th The insane may feign insanity when accused of 
crime, and a new complication thereby enters into the 
question of diagnosis. It may be of interest here to note 
that Dr. Ray's theory that Hamlet was an insane man 
feigning insanity, will better explain the psychological 
problem presented in this play than any theory yet 
suggested. 
* Medical Gazette March 15, 18S0 
t Gaillard's Medical Journal, Vol. II., p. 463, 1880. 
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