THE PSYCHOSES WITH PSYCHOPATHIC PERSONALITY
The introduction of the term psychopathic personality is probably to be
attributed to the description of "Die Psychische Minderwertigkeiten"
by Koch in 1893. These were referred to by Morel[337] as "Psychopathic
Depreciations," a group in which he says Koch included "a very large
number of these psychical manifestations, so varied in their nature
and intensity which, without belonging to the class of mental diseases
proper, cannot, nevertheless, be reconciled with the idea of perfect
mental sanity." These were described as being either congenital or
acquired and including psychopathic predisposition, psychopathic
defect and degeneration. To congenital defects were attributed the
"Eccentrics, disequilebrated, overscrupulous and capricious persons,
foolish, misanthropes, redressers of wrong, reformers of society,
etc." In the degenerative processes he included mental deficiencies
both intellectual and moral. Meyer,[338] who based his conception of
"constitutional inferiority" largely on the work of Koch, says that
the latter by "Psychische Minderwertigkeiten" "meant those little
defects which constitute the inferiority of the individual in the whole
strife of life, that inferiority which does not allow him to come up
to an actually efficient balance in the struggle of life.... They
were oddities, peculiar nicks in the personalities of the various
people, and he designated those as constitutionally inferior." Koch
in this grouping unfortunately included hysteria, psychasthenia and
neurasthenia. Meyer eliminated these: "I wanted to do justice to the
hysterias and psychasthenias which I could define as such, but I knew
there was a whole group of cases in which the definition could not
be pushed. I also knew that it was difficult to give the definition
in the downward line towards imbecility, and since it was so very
hard to give the definition in the individual cases, I thought that
the least trouble would arise from making a relatively large group
of 'inferiorities not sufficiently differentiated' and let those be
entered under the heading of 'constitutional inferiority.'"
The original conception of this group was that it included intellectual
defects which have subsequently been classified with the mental
deficiencies, leaving only those cases showing purely psychopathic
taints of a constitutional origin. There have been numerous other
descriptions of these conditions. Ziehen[339] included under the
psychopathic constitution "chronic, psychopathic conditions, which
in their symptomatology and course not only involve defect of the
affectivity but also of the intelligence, even though pronounced
psychopathic symptoms, such as delusions, hallucinations, etc., do not
intrude for any extended period. Where hallucinations and analogous
symptoms do appear they are solitary and the patient retains insight
into the condition." Ziehen's psychopathic constitution covers a very
wide field, including not only hysteria and neurasthenia but epilepsy.
The psychopathic personalities as described today represent only
a modern interpretation of conditions which have been given
ample consideration in the psychiatric literature of the past.
An early illustration of this fact is Pritchard's definition of
"moral insanity" in 1835:—"A morbid perversion of the feelings,
affections and active powers, without any illusion or erroneous
conviction impressed upon the understanding; it sometimes coexists
with an apparently unimpaired state of intellectual faculties."
The psychopathic states were undoubtedly fully covered in Morel's
description of the insanity of degeneracy in 1860. This he divided
into cases arising from constitutional nervous temperaments, moral
insanity, the feebleminded with or without morbid impulses, and those
with criminal tendencies. This conception was well summarized by
Diefendorf[340]:—"The disharmony of the intellectual and the moral
faculties is one of the most striking features of degeneracy. As in
the defects of the intellectual development, so in the moral sphere,
the condition varies from a complete arrest of moral development to
all forms of moral perversion and even to an abnormal development of
the moral and emotional susceptibility. All of these conditions may
exist, with a perfect development of the intellectual faculties.... The
professional criminals should also, without doubt, be included in this
class, as they present all possible varieties of moral perversions and
anomalies, all of which may exist with preservation of the intellect
and even with intellectual keenness."
Magnan described compulsions, impulsions and contrary sexual instincts
as episodes of the insanity of degeneracy. The psychopaths were
undoubtedly the "déséquilibrés" or ill-balanced individuals of
Régis,[341] whose work on "Mental Medicine" included an exceedingly
elaborate discussion of the so-called "borderline" conditions.
"After maturity they are complex beings, heterogeneous, made up of
disproportioned elements, contradictory qualities and defects, and
as over-endowed in some directions as they are deficient in others.
Intellectually, they often possess in a very high degree, the faculties
of imagination, of invention, and of expression, that is to say, the
gifts of speech, the arts, and poetry; on the moral side, they possess
a singular emotivity, or rather, sensibility. What they lack, more or
less completely, is good judgment, the moral sense, and especially
continuity or logical consecutiveness, a unity of direction in
intellectual production and the actions of life. It follows, that in
spite of their often superior qualities, these persons are incapable
of conducting themselves in a rational manner, of following regularly
the exercise of a profession that seems well beneath their capacity, of
looking after their interests or those of their families, of carrying
on business prosperously or of directing the education of their
children; their existence, therefore, constantly recommencing, is one
long contradiction between the apparent wealth of means and poverty
of results. They are the utopians, the theorists, the dreamers, who
are enamored with the best things but accomplish nothing. The public
which sees only the brilliant exterior looks upon these individuals as
artists and superior beings. The medal is reversed, however, to those
who are compelled to associate with them and share their existence;
they see their defects, their incapacities and evil tendencies, of
which they are not merely the witnesses, but also the victims. Aside
from their lack of mental poise these individuals also display an
excessive emotional sensibility and an enfeeblement of psychic energy
that reveals itself by a noticeable predominance of spontaneity over
reflection and volition. Hence their inability, their instability,
and their irresolution; hence also their alternations of apathy and
activity, of excitement and torpor, their violent attacks of passion
and their cries of despair for the most trivial and slightest reasons."
Régis divided the "psychic discordances" or disharmonies into the
ill-balanced, the original and the eccentric. These were all included
in the degeneracies of evolution. Clouston covers this same ground
fully and in a somewhat similar manner in his "Unsoundness of Mind"
(1911).
The insanities of degeneracy have also been given considerable space by
such Italian writers as Lombroso, Bianchi, etc. Lombroso in "The Man
of Genius" (1888) discussed this subject as follows:—"A theory, which
has for some years flourished in the psychiatric world, admits that
a large proportion of mental and physical affections are the result
of degeneration, of the action, that is, of heredity in the children
of the inebriate, the syphilitic, the insane, the consumptive, etc.;
or of accidental causes, such as lesions of the head or the action of
mercury, which profoundly change the tissues, perpetuate neuroses or
other diseases in the patient, and, which is worse, aggravate them in
his descendants, until the march of degeneration, constantly growing
more rapid and fatal, is only stopped by complete idiocy or sterility.
Alienists have noted certain characteristics which very frequently,
though not constantly, accompany these fatal degenerations. Such are,
on the moral side, apathy, loss of moral sense, frequent tendencies
to impulsiveness or doubt, psychical inequalities owing to the excess
of some faculty (memory, aesthetic taste, etc.) or defect of other
qualities (calculation, for example), exaggerated mutism or verbosity,
morbid vanity, excessive originality, and excessive preoccupation with
self, the tendency to put mystical interpretations on the simplest
facts, the abuse of symbolism and of special words which are used as an
almost exclusive mode of expression."
Several other very elaborate works have been published on the subject
of degeneracy. One of the better known of these perhaps is that of
Max Nordau on "Degeneration" (1894). The book of Grasset[342] on the
"Demifous et Demiresponables" has been translated into English and
constitutes one of our most valuable contributions on this subject.
Grasset credits Trélat with making the first comprehensive study of the
semi-insane in his "La Folie Lucide," etc., in 1861. His classification
of these conditions included imbeciles, the feebleminded, satyrists,
nymphomaniacs, monomaniacs, erotomaniacs, jealous individuals,
dipsomaniacs, spendthrifts, adventurers, the conceited or boastful,
evildoers, kleptomaniacs, suicides and the inert and lucid manias.
Grasset gives some interesting illustrations of the psychopathic traits
of various men of genius. Tolstoï fell sixteen feet as a result of
attempting to fly when eight years old, and whipped himself with ropes
to become accustomed to pain. In school he chose a course in Oriental
languages because everyone else was interested in law. Not being able
to finish a college career in two years, he decided to go to a desert
and live a purely animal life. It was necessary for him to resort to
devices of various kinds to prevent suicide. Rousseau was at various
times a clockmaker, music master, painter and servant in addition to
studying medicine, music, theology, and botany. He dedicated a pamphlet
"to all Frenchmen who were friends of justice" and distributed it on
the streets. One of his acts was to write a letter "to God Almighty"
and place it under the altar of Notre Dame. Persecutory ideas were
entertained by him for years. Emile Zola was evidently a psychasthenic
as well as a psychopath. He counted the gas jets on the street, the
numbers on the doors, and the cabs passing by. These were added
together. "For a long time the multiples of three seemed to him of
good omen, then the multiples of seven were reassuring." "For a long
time he was afraid he would not succeed in any proceeding on which he
was about to enter if he did not leave the house with his left foot
first." Balzac had an ambulatory mania and could not be found when
called for military service. It is said that on one occasion "when he
had put on a handsome new dressing gown he wanted to go out into the
street with it on with a lamp in his hand to excite the admiration of
the public." His father is said to have stayed in bed for twenty years
without any reason for so doing, suddenly resuming his former mode of
life at the end of that time. Schopenhauer broke a hotel proprietor's
arm because he heard him talking outside of his room. He refused to pay
a legitimate account because his name was spelled with two p's instead
of one, on the bill. He often burned his beard instead of shaving and
wrote his notes in Greek, Latin and Sanskrit for fear someone would
read them. In his will he left all of his possessions to soldiers and
to his dog. Goethe alternated between great joy and extreme depression
and had unjustifiable attacks of anger. Frederick II had such a
dislike for changing his coat that he had only two or three during the
course of his life. When Schiller wanted to meditate he had a habit of
putting his feet on ice and sniffing the aroma of fermenting apples.
Nordau says "that Richard Wagner is accused of having a greater degree
of degeneracy than all the degenerates that we have thus far seen
put together." Mozart played the harpsichord at three years of age,
composed concertos at five and made a concert tour at the age of six.
He was extremely nervous and fell in love at fifteen with a girl of
twenty-five. In the last months of his life he was obsessed with the
idea that he had to prepare his own funeral mass. Lombroso's theory
is that "genius is a true degenerative psychosis, belonging to the
group of moral insanities which may temporarily spring from other
psychoses and take their form, but always conserving certain special
characteristics which distinguish it from the others." Although his
conclusions may not be warranted it must be admitted that many men of
genius have been psychopaths.
Kraepelin[343] in discussing the influence of heredity on psychoses and
personalities, says, "Hence we may, perhaps, discriminate between
congenital states of disease and morbid personalities, according as the
disturbances are apparently the expression of the morbid conditions of
past generations, or seem to be purely personal abnormalities, although
it is certainly impossible to make any sharp distinction." In 1915, in
the fourth volume of his eighth edition, Kraepelin devoted nearly one
hundred and fifty pages to the subject of psychopathic personalities.
These he divides into the excitable, the unstable, the impulsive,
the eccentric, the liars and swindlers, the antisocial or enemies of
society, and the quarrelsome.
A study of the "excitable" psychopaths in Kraepelin's[344] clinic
showed the intellectual standard of these individuals to be above the
average. Apprehension and judgment were unimpaired even when mental
inferiority was not entirely lacking. Some complained of poor memory
or absentmindedness, others of a feeling of fatigue. A definite mental
activity was noted, usually of a happy mood, but occasionally with
depressive tendencies. The characteristic feature was an emotional
excitement, associated often with violent rages, without any adequate
reason. The emotional reaction changed quickly to one of despair,
anxiety, irritability or inaccessibility. The mood in a large number of
cases was depressed and tearful, while others were cheerful and elated,
laughing and joking, or erotic. Often without any apparent cause,
irritability, pessimism, unsociability, weariness of life and thoughts
of suicide appeared—more particularly during menstrual periods. The
emotional state as a rule was kind, affable, good-natured, tractable,
often religious, sensitive or sympathetic. The patients are often
spoken of as well-liked, industrious, honest and substantial citizens.
Some are timid, bashful or gloomy in disposition. Others are conceited,
overbearing, tyrannical, rude, unsociable and quarrelsome. Many are
childish, foolish or eccentric, highstrung and affected or untruthful.
Some are unsteady, restless and over-occupied, full of schemes, rash,
talkative, gossiping, and assuming striking mannerisms. Occasionally
they are disinclined to any regular occupation, neglect their work,
loaf around and are supported by their relatives. In sixty-two per cent
of these cases the patients were brought to the clinic on account of
suicidal tendencies. This was due to reduced circumstances in nearly
fifty per cent of the men and in seventy-one per cent of the women. In
the men marital troubles and love affairs were more common; sometimes
loss of position, or death in the family, etc. Spurious attempts at
suicide of a theatrical type were frequently reported. Next to suicidal
inclinations as a cause for being brought to the clinic there were
assaults, attacks of rage and outbursts of despair. In any stress or
anger over a disagreeable occurrence these individuals are likely to
become abusive, shout, scream, run around, strike the head against
the wall, tear their clothes off, pull out their hair, etc. Some
rush around all night in the streets in a senseless rage, improperly
clothed. Occasionally they attack others unjustifiably and for no
apparent reason. They are exceedingly susceptible to alcohol. During
their excitements, consciousness may be clouded. Afterwards they say
they were confused, not themselves, in a dream as it were, etc. Some
have no recollection whatever as to what was done. These excitements
rarely last more than a few hours. Thirty-two per cent of the men and
less than ten per cent of the women were convicted of crime, usually
for disturbing the peace, or criminal assaults, but occasionally for
much more serious offenses. As a rule alcohol is a factor in these
cases. The relations between the sexes are characterized by jealousy
and quarreling. The women are particularly likely to have delusions of
infidelity. Genuine hysterical attacks occur in a certain number of
cases. They often see visions and may have dizzy spells or syncopes.
Somnambulism may occur. Nervous symptoms often appear—headaches,
unpleasant dreams, palpitations, tremors, increased reflexes,
tics, etc. The excitable cases constituted nearly one-third of the
psychopaths admitted at Kraepelin's clinic. Sixty per cent of these
were women. The majority of cases were between fifteen and twenty-five
years of age. Heredity appeared to be a factor in forty-seven per
cent and many showed physical defects. Fifty per cent of the men were
intemperate.
The "unstable" psychopaths are characterized by a dominating weakness
of the will. In nearly one-half of the cases the intellectual
endowment is normal, some having a surprising power of comprehension
and ability to take up new things, with accurate observation of their
surroundings and keen discrimination. These persons have no great
persistence and do not exert themselves, are inattentive, tire easily
and are distractible. They never go into things deeply and have only a
superficial knowledge of events. They learn readily and forget quickly.
The memory is poor and unreliable. The imagination is usually very
active, with a tendency to exaggerate, dream of the impossible and
relate great stories. There is an inclination to boast and fabricate,
telling of wonderful but wholly imaginary deeds and accomplishments.
They often represent themselves to be important personages. Some show
artistic talent, write plays or fantastic poetry and discuss literary
and dramatic problems. They are strongly inclined to become actors. The
higher intellectual development is uniformly defective. Comprehension
is not clear and judgment is immature and short-sighted. Their
interests are devoted to frivolous matters without much attention to
more important questions. They sometimes show great prospects in school
but do not fulfill them later. The mood is cheerful and conceited, with
a very high opinion of themselves and great ambitions. They blame their
relatives for their lack of success and claim they are not understood
or appreciated. Sometimes the emotional trend is more sad and gloomy.
They complain of being unlucky, everything goes wrong. Occasionally
anxieties appear, with a feeling of oppression, fear of being alone, of
mental troubles or suicide. These feelings are, however, superficial
in character, usually disappearing in a short time, to be followed by
excitement, outbursts of anger or anxiety. They are often quarrelsome.
The characteristic disturbance, however, is that of the will. They are
entirely lacking in the capacity to stick to any one occupation. They
are not punctual, are interfered with in innumerable ways and often
change their work, looking for something more suitable. Hypochondriacal
notions hamper their activities. Senseless journeys and trips are often
undertaken. Some become vagabonds and tramps. They are much inclined
to bad company and resort to immoderate use of tea, coffee, drugs and
alcohol. Sixty-four per cent of Kraepelin's male cases and twenty per
cent of the women were intemperate. The sexual habits are very often
irregular and venereal diseases to be expected. Kraepelin found either
gonorrhea or syphilis in twenty-two per cent of the women examined.
Some exhibited homosexual tendencies. Many become spendthrifts, making
extravagant and foolish purchases. They are inclined to speculate
unwisely. Fifty-four per cent of the men and nearly a third of the
women as a result of their moral deterioration come into conflict
with the courts on account of thefts, assaults, quarrels, vagrancy,
etc. Suicidal tendencies were shown in forty-eight per cent of the
men and sixty-five per cent of the women in Kraepelin's clinic. In
many cases these were induced by alcoholism, in other instances by
family quarrels, etc. Often the reasons given were foolish. Hysterical
attacks appear in a certain percentage of cases in the women. Some had
hallucinations and confusional attacks or syncopes. Tremors, headaches,
increased reflexes and other neurological symptoms occasionally
appeared. The "unstable" group included about one-fifth of the
psychopaths observed by Kraepelin. Thirty-six per cent of these were
women. The majority of those admitted were between the ages of fifteen
and twenty-five. Heredity was a factor in forty-nine per cent of the
cases.
The "impulsive" psychopaths are characterized by a domination of
the conduct by emotional impulses. The intellectual makeup of these
individuals is usually good. They often have a special bent for art,
music, poetry, etc. They frequently show a considerable mental activity
and versatility. They express themselves well, make witty remarks and
appear brilliant, although they may complain of absentmindedness or
fatigability. They are always conceited, born to greater things and
have a great future. There is an almost unbounded egotism in some
cases. The emotional tone is good-natured, easygoing and accessible.
Many are sensitive and visionary; others obstinate, inconsiderate,
pretentious or quarrelsome. The mood is usually high-spirited and
confident but variable. The patients are often depressed and hopeless,
complaining of their luck. At other times they are sullen, surly,
irritable and faultfinding. Many exhibit suicidal tendencies. An
emotional irritability is exceedingly common, with violent outbursts
of anger. Often they refuse to associate with others for a time and
will speak to no one. The three common types are the spendthrift, the
wanderer and the dipsomaniac. The spendthrifts usually indulge in
alcohol and naturally soon contract enormous debts. They frequently
have little insight into their condition or blame someone else
for it. Many become wanderers and go aimlessly from one place to
another—wherever their inclination leads them. The memory for these
events is good. Some inadequate reason is always offered. These
wanderers usually are children between the ages of ten and fifteen.
The impulsive alcoholics may have attacks very rarely, sometimes only
once a year. Debauches are preceded by restless and moody conduct.
After constant drinking for days or weeks they sometimes have suicidal
impulses. Sexual excitements may occur. They always show psychopathic
traits between attacks. They are unsteady, unreliable, make sudden
resolutions, change their occupations and residence and lead a wild
existence with surprising adventures. Some have hysterical attacks,
fainting spells, or even convulsions. The impulsive psychopaths
constituted only two or three per cent of Kraepelin's cases.
Practically all were over twenty-five years of age. There was a
hereditary taint in seventy-one per cent of the cases.
The "eccentric" psychopaths are characterized by a lack of uniformity
and consistency in the mental makeup. The intellectual endowment of
these individuals is usually normal. They are often absentminded,
forgetful and show a variation in productivity. Some are artists
or devote themselves to inventions. Judgment is impaired and
reasoning becomes distorted and onesided. There is a tendency towards
exaggeration and extravagance in their viewpoints, with a leaning
towards queer notions. They are often quickwitted, versatile and write
long and wordy documents. Their mode of expression is bombastic and
labored, and the content of speech or writing, verbose, desultory,
flighty and full of meaningless expressions. They show a certain
shrewdness and cunning, dissimulate, resort to all kinds of evasions,
and are conspicuous in their conduct. Occasionally there is a tendency
towards delusional ideas of a mild form. As a rule the mood is
cheerful, although often depressed, suspicious or irritable. They are
opinionated, boastful and better than others. Usually there is an
emotional excitability. The patients are sensitive and irritated by
small things, scold and complain. Sometimes they are sentimental and
dreamy, with extravagant language. They often take sudden dislikes to
brothers, sisters or other members of the family. They are capricious,
quarrelsome, and faultfinding. Their conduct is aimless, contrary
and incomprehensible. They lose all capacity for judgment of real
conditions. They cannot proceed in any orderly way in things which they
are really fitted for. They do not stick to anything long, changing
plans and occupations frequently. They often go about at night talking,
arguing and drinking. It is not unusual for them to quarrel with
their wives or even commit assaults. The majority of these eccentric
psychopaths were men over thirty-five and of degenerate families. This
group constitutes only a small number of cases.
The "liars and swindlers" are characterized by an excitability of
the imaginative faculties and a variable and uncertain will power.
At first these individuals are likely to appear as unusually gifted
persons. They are good-natured, present an excellent appearance and are
apparently well informed on almost all subjects. They have a faculty
for quoting foreign languages and sometimes are familiar with many
tongues. Often they are brilliant conversationalists. On investigation
their actual knowledge is found to be very superficial. They are
inclined to art, poetry and literature. Many become interested in
hypnotism or spiritualism. They are inclined to join religious sects
or attach themselves to the Salvation Army. These individuals learn
quickly but do not stick to things long. Their mental powers are not
orderly or consistent. They have an extraordinary imagination but
accomplish nothing. They are liars from birth, the falsifications
usually being entirely useless. Many are anonymous letter writers.
They are often unable to discriminate, themselves, between the true
and the false in their own stories. These fabrications appear to be
an emotional product, the imaginary occurrence practically always
relating to the individual himself. They boast of their superiority in
literary and scientific accomplishments and claim to be theologians,
mathematicians, jurists, chemists, etc. In their imaginations and
fabrications the patients always better themselves. In many instances
they assume pretentious titles, represent themselves as counts,
princes, etc. Sometimes they strongly suggest paranoia. In a small
number of cases self-accusations appear and they confess to all kinds
of imaginary crimes. As a rule they are elated and optimistic, but
often affected and theatrical. Occasionally suicidal attempts are
made. At times general depressions or anxious states appear. Some are
coarse and deceitful. They are usually uncertain and capricious in
everything. Some become spendthrifts. They are naturally cheats and
swindlers; occasionally thieves. The swindling schemes resorted to are
innumerable. The use of false names and assuming of uniforms and titles
of various kinds is the most common. They make purchases of all kinds
without any ability to pay or any intention of doing so. Many refuse
to pay bills without any excuse whatever. Others attempt to marry rich
women by deceitful means and misrepresentations. Some practice medicine
without a license; others claim damages for imaginary injuries.
Sexual offenses are common. If arrested they are often inclined to
claim amnesia for the period of time when the act was committed. They
occasionally have genuine psychoses and hysterical attacks. These
simulate various diseases. The group of liars and swindlers constituted
from six to seven per cent of the psychopaths in Kraepelin's clinic.
Seventy-one per cent of the men were accused of crimes. The majority
of cases were under twenty-five years of age. Heredity was a very
important factor.
The "antisocial" psychopaths or enemies of society are characterized
by a blunting of the moral elements of their makeup and a lack of
adjustment to their environment. Kraepelin found that forty per cent
of his cases were persons who had done well in school. They have a
strong dislike for regular occupations and avoid them in every possible
way. Their behavior is variable, with a tendency to be industrious
occasionally and more often lazy. Frequently they appear queer,
abstracted, inattentive, dreamy, sleepy or dull. When at their best
they are not bright mentally and have no ambition or far reaching
interest. They learn quickly and forget as rapidly. Their store of
knowledge is very limited. They have no capacity for going into things
thoroughly and cannot acquire a higher education. They are lacking
in judgment, foresight and discrimination. Many have a weakness for
cheap stories of adventure, pictures of crime, etc. In expression they
are usually quick as well as verbose. A characteristic is their lack
of truthfulness. They are liars and braggarts. The mood is usually
cheerful and confident; sometimes arrogant, surly, moody, irritable and
occasionally depressed or anxious. They change unexpectedly from one
mood to the other. Irritability, with outbursts of anger, is common.
They often become threatening and destructive. Eighteen per cent of
Kraepelin's cases attempted suicide. At least one-third of these were
theatrical attempts on account of fear of punishment. Childish vanity
and conceit is a very common symptom, with boastful tendencies. A
prominent feature is the lack of any deep emotional reactions. They
do not react normally and properly to their surroundings. Another
characteristic defect is their entire lack of sympathy for anyone else.
They are likely to be cruel to animals as well as persons. They show
little affection for parents, children or relatives and are lacking
in a sense of decency and personal cleanliness. As children they
are exceedingly troublesome in school. Some have to go to custodial
institutions for care. Many are truants at school and run away from
home, becoming wanderers and vagabonds. They are inclined to sexual
excitement, irregularities and crimes of various sorts. Seventy per
cent of Kraepelin's cases were thieves, beginning to steal as children;
twenty per cent were embezzlers and twelve per cent guilty of fraud
or forgery. Practically every variety of crime was represented. They
exhibit an extraordinary tendency to revert to criminal habits. Prison
life makes some submissive but starts others in a war against society.
They often attempt violence or make passive resistance to the law. They
occasionally develop hypochondriacal tendencies. Friendly advances are
greeted with mistrust. Some are stubborn, sulky, unrepentant and have
nothing to say, or lie and explain by putting the blame on others. Thus
an opposition to all organized society develops. They often look upon
themselves as martyrs. Others take the situation lightly and minimize
the gravity of their position. Some seem to really see the error of
their ways. The antisocial individuals sooner or later, like other
psychopaths, are very prone to hysterical attacks, fainting spells,
or even convulsions. Anesthesias and hyperesthesias may be noted.
Some patients complain of headache, disturbed sleep, dreams, etc. The
antisocial in Kraepelin's clinic constituted less than ten per cent of
the psychopaths, of which seventy per cent were men. Half of the women
were prostitutes. Over eighty per cent of the cases were under twenty
years of age.
The intellectual makeup of the "quarrelsome" psychopath is usually
fairly good. As a rule these persons show a narrowing of the
intellectual sphere, with, however, a well-defined shrewdness which
enables them to take advantage of others. Some show a tendency to
pedantry and hair-splitting arguments. Memory is good but distorted
by an emotional coloring. Judgment is warped and unreliable. They
are credulous and accept statements without proof, but they look
with suspicion on anything not in accord with their own ideas. The
influence of these factors leads to an emotional excitability. They
are always passionate, sensitive individuals who become excited over
trivial matters. This is complicated by a marked self-confidence,
minimizing their own failings. Quarrels are the inevitable consequence.
Everything is exaggerated in importance. The conclusion is reached that
the neighbors and others are all organized against them. Sometimes
the feeling of enmity is transferred from one individual to another.
The patient is constantly in trouble with someone. They are almost
invariably of the male sex and usually of middle age or older when they
come under observation.
For statistical purposes the differentiation of the psychopathic
personalities has been described by the Association's committee as
follows:—
"Under the designation of psychopathic personality is brought together
a large group of pathological personalities whose abnormality of makeup
is expressed mainly in the character and intensity of their emotional
and volitional reactions. To meet the demands of current usage, the
term for this group has been shortened from the older one "psychoses
with constitutional psychopathic inferiority" with which it is
synonymous. Individuals with an intellectual defect (feeblemindedness)
are not to be included in this group.
"Several of the preceding groups, in fact all of the so-called
constitutional psychoses, manic-depressive, dementia praecox, paranoia,
psychoneuroses, etc., may be considered as arising on a basis of
psychopathic inferiority or constitution because the previous mental
makeup in these conditions shows more or less clearly abnormalities in
the emotional and volitional spheres. These reactions are apparently
related to special forms of psychopathic makeup now fairly well
differentiated, and the associated psychoses also have their own
distinctive features.
"There remain, however, various other less well differentiated types
of psychopathic personalities, and in these the psychotic reactions
(psychoses) also differ from those already specified in the preceding
groups.
"It is these less well differentiated types of emotional and volitional
deviation which are to be designated, at least for statistical
purposes, as psychopathic personality. The type of behavior disorder,
the social reactions, the trends of interests, etc., which psychopathic
personalities may show give special features to many cases, _e.g._,
criminal traits, moral deficiency, tramp life, sexual perversions and
various temperamental peculiarities.
"The pronounced mental disturbances or psychoses which develop in
psychopathic personalities and bring about their commitment are varied
in their clinical form and are usually of an episodic character. Most
frequent are attacks of irritability, excitement, depression, paranoid
episodes, transient confused states, etc. True prison psychoses belong
in this group.
"In accordance with the standpoint developed above, a psychopathic
personality with a manic-depressive attack should be classed in the
manic-depressive group, and likewise a psychopathic personality with a
schizophrenic psychosis should go in the dementia praecox group.
"Psychopathic personalities without an episodic mental attack or any
psychotic symptoms should be placed in the _without psychosis_ group
under the appropriate subheading."
Unfortunately there are no statistics which show the incidence of
psychopathic personalities in the community. A study of 70,987 first
admissions to state hospitals shows that the psychoses associated with
this condition constituted only 1.12 per cent of the total number. On
the other hand, the reports of the Phipps Psychiatric Clinic show an
admission rate for psychopaths of over six per cent during a five-year
period. When they reach a state hospital it is usually owing to the
development of manic-depressive insanity or some other well-defined
psychosis. The important and troublesome cases from a social point of
view are those that do not reach hospitals. A much larger percentage is
to be found in institutions of the correctional and penal type. There
is no greater problem today than the attitude of the state towards
the psychopathic criminal. The influence of these individuals on the
community at large is something that we have no means of estimating at
the present time.