skip to main content

Automatism vs Insanity — MRCPsych Paper B MCQ

Instant feedback + full explanation. One question, done properly.

HardForensic PsychiatryAutomatism vs InsanityMRCPsych Paper B

In England and Wales, expert evidence establishes complete destruction of voluntary control during each of two alleged offences. Episode 1 followed an unexpected blow to the head causing transient concussion. Episode 2 occurred during an epileptic seizure; the resulting defect of reason meant that the defendant did not know the nature and quality of the act. Which statement best describes the legal classification and usual Crown Court outcome?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Episode 1 is non-insane automatism with complete acquittal; episode 2 is insanity with a special verdict because its cause is internal.

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as D · D = shown as E

B is correct. Once complete involuntariness is established, English law distinguishes non-insane automatism from insanity principally by causation. Transient concussion from an unexpected blow is an external factor and may support non-insane automatism, producing a complete acquittal. Epilepsy is treated as an internal disease of the mind; because the stem also establishes the required M'Naghten defect of reason and lack of knowledge of the act's nature and quality, the Crown Court outcome is the special verdict of not guilty by reason of insanity. A is wrong because complete loss of control alone does not determine classification. C wrongly assumes that a neurological condition cannot be a legal disease of mind. D overstates the meaning of medically explained involuntariness, while E ignores the internal–external causal distinction.

Reference: Law Commission, Fourteenth Programme of Law Reform, section 'The Defence of Insanity', paragraphs 2.13–2.16 and footnote 14, 2025. https://assets.publishing.service.gov.uk/media/68b95657b0a373a01819fdec/14th_programme_-_with_covers_for_web_and_digital_laying.pdf