D was a diabetic and, having neglected to eat or drink or taken insulin in several days and committed some crimes, including driving without a license, in a state of hypoglycaemia, possibly contributed towards by stress and anxiety. The trial judge directed on insanity but not on automatism, saying that it didn’t apply. D appealed on the basis that stress, anxiety, depression etc were external factors which therefore made automatism the appropriate defence. CA rejected his appeal since, although stress etc may have contributed to hypoglycaemic state, his state was overall caused by a disease, namely diabetes and therefore automatism didn’t apply. Lord Lane said that if failure to appreciate nature and quality of act/omission was due to defect of mind then insanity is appropriate direction. If it did not occur due to a defect of mind then automatism is correct direction. Lord Lane also asserts that depression anxiety etc, though possibly caused by external factors are nevertheless internal mental problems.