Automatisms: Bridging clinical neurology with criminal law

The law, like neurology, grapples with the relationship between disease states and behavior. Sometimes, the two disciplines share the same terminology, such as automatism. In law, the “automatism defense” is a claim that action was involuntary or performed while unconscious. Someone charged with a serious crime can acknowledge committing the act and yet may go free if, relying on the expert testimony of clinicians, the court determines that the act of crime was committed in a state of automatism. In this review, we explore the relationship between the use of automatism in the legal and clinical literature. We close by addressing several issues raised by the automatism defense: semantic ambiguity surrounding the term automatism, the presence or absence of consciousness during automatisms, and the methodological obstacles that have hindered the study of cognition during automatisms.

Research Highlights► We reviewed cases involving the automatism defense in California since 1850 (n = 149). ► We also explored the use of automatism in the epilepsy literature (n = 179 reports). ► We found that the automatism defense is typically used with a loose definition. ► The legal proceedings have relied on the opinion of individual clinicians. ► Systematic studies of ictal cognition or postictal state are needed.