these grandiose ideas. One of them thought that he had in his
possession immense wealth in the shape of large checks, signed
supposedly by various important capitalists, and even foreign rulers.
These checks were actually signed in the names of these personages, at
the tramp's own request, by any chance passer-by or acquaintance. This
patient died in a country insane asylum in the demented stage of
paranoia, having gone through all the usual phases of the disease.
Another tramp was confident that each recurring election he was to be
elected to one of the highest offices in {298} the state, or even to
be made President of the United States. Not every one was taken into
his confidence in this matter, however. The simplest declaration after
the election from any chance acquaintance would assure him of his
success at the polls, and on more than one occasion he turned up at
the Capitol to claim exalted office, but was generally inoffensive in
his ways, and was rather readily persuaded that his term of office did
not begin for some time. It is easy to understand that a person might
come into the possession of the idea that the official holding office
in his stead should be removed; the result might very well be one of
the sad tragedies supposedly due to anarchism, but really to paranoia.
Of course as with criminals, so with tramps; not a few of them take up
this manner of life without any sufficient justification in their
mental state to lessen our worst opinion of them. I do not think I
should hesitate to say, however, that the majority of these
unfortunates present distinct signs of physical and mental
degeneration and are rather deserving of pity and care than of
condemnation. They need, as a rule, very special environment to enable
them to lead ordinary, respectable lives, because they were not
originally endowed with sufficient initiative and independence of
spirit to enable them to carry on the struggle for life in the midst
of the hurry and bustle of our modern civilisation. As the pressure of
the time becomes severer, more of these unfit come into evidence. They
arc examples of the lowered mental states, unable to stand the rivalry
with fellowmen, and ready to give up the struggle whenever the example
of others who have already given it up is brought prominently to their
notice.
It is not a little surprising how many of these tramps belonged
originally to excellent, respectable families. Careful investigation
of their personal history, however, will show that they have been, as
a rule, backward children at school, always a little awkward in the
way they took hold of things early in life, unsuccessful in the
rivalries of school competitions, and in their first efforts at labour
after school days were over. They always needed the encouragement of
those whom they loved and respected, to keep them at their
unsatisfactorily fulfilled tasks. They were the predestined failures
{299} in life, and have found out their uselessness early in their
careers. This is the view of tramp life that is coming to be realised
as true by all those who have studied the question, not from the
standpoint of theory, but of practical experience with it.
_So-called Monomania_. The old term for paranoia employed for a long
time was monomania, a word coined by Esquirol at the beginning of the
nineteenth century. This word has dropped out of the terminology of
mental diseases because there is no such thing as a patient suffering
from a single symptom of mental disturbance, that is, being mentally
perturbed on but one line of thought. There are always others, though
they may be hidden except from the careful investigator. When Esquirol
introduced the term he applied it to the most prominent symptom of the
patient's mental alienation, but did not intend it to be taken as
excluding other symptoms by which the essential nature of the
patient's insanity could be diagnosed. Careful study will always
disclose the fact that other symptoms are present. The word monomania
has been an unfortunate one for scientific psychiatry, because it has
been abused to shield criminals. The plea is often heard that a person
under charge of crime is really subject to some mania that brought
about the commission of the crime.
We often hear of kleptomania as a defence for persons who have failed
to recognise the distinction between _meum_ and _tuum_, and are haled
before the court because of the detection of infringements of this
distinction. True kleptomaniacs there are, but there are always other
symptoms of their mental disturbance besides the tendency to steal.
Their queerness in other ways has usually been recognised by their
friends and by their family physician before the incident which calls
attention to this special form of disequilibration occurs.
Kleptomaniacs, too, are usually prone to take things of little value,
or not especially suited to their wants and for which they have
practically no use.
It is true collectors, that is, those who have a hobby for gathering
curiosities of one kind or another to make a collection, may become so
interested in additions to their collection {300} as to be tempted to
appropriate to themselves articles of which they can not otherwise
obtain possession. Such actions may easily go beyond the bounds of
reason. It must be remembered however, that the collection mania
itself is often so pronounced as to be a little beyond the bounds of
ordinary rationality.
Other so-called monomaniacs have the same characteristic and are
associated with related symptoms of mental disturbance. Pyromania is
sometimes pleaded as a defense for arson. It is a legitimate defense,
however, only when the careful tracing of the patient's history
beforehand shows the existence of other symptoms of mental unbalance.
The homicidal mania is of the same order. There have been cases where
men seem to have delighted in inflicting injuries or death upon fellow
creatures from pure malice. Such cases as that of Jack the Ripper, for
instance, are undoubtedly due to a special tendency to take life. In
these cases, however, associated symptoms are never lacking. It is not
improbable that in Jack the Ripper's case a sexual element was
present, because the victims were always of one low class, and that
the general character of the murderer would have revealed his
irresponsibility. There are several stories of children--whose mothers
delighted in seeing their husbands, who were butchers, slaughter
animals--who seem to have had a veritable mania for seeing blood flow
and to have exercised it in the murder of human beings.
Only the most careful examinations of the previous life of the
patient, the investigation of childish tendencies and habits at
school, and the incidents of boyhood and youth will sometimes enable
the expert to recognise the constant existence of symptoms of mental
disequilibration, the decided manifestation of which leads to serious
events in after life. Monomania as a defense for crime has brought
expert evidence into great disrepute. In this matter the greatest care
is undoubtedly needed, however, for it is easy to do great wrong and
punish the irresponsible victim of an impulse over which he has no
proper control. On the other hand, it must not be forgotten that no
such thing is known to exist as the perversion of the will on a single
point. Moral insanity with regard to one special set of actions is a
delusion that the {301} increase of knowledge with regard to mental
diseases has erased from the text books on this subject.
_Responsibility of Paranoiacs_.--From what has been said it is easy to
understand how difficult is the determination of the responsibility of
paranoiacs. Many classes of persons ordinarily considered to be quite
responsible for their actions are yet so circumstanced that they are
led into the performance of actions usually not considered rational,
though not tempted thereto by any benefit directly accruing to
themselves. On the contrary, it not infrequently happens that the mode
of life adopted by the paranoiacs is of such a kind as would of
itself, because of the hardships involved or the mental trials, deter
ordinary people from following it. Paranoia, at least in its severer
forms, completely justifies the plea of irresponsibility for actions
committed. When it is remembered, however, that paranoiacs are often
cunning enough to take advantage of their own supposed queerness
voluntarily to commit crimes they might otherwise be deterred from by
fear of punishment, some idea of the difficulty of the decision in
these cases may be appreciated.
It is important, of course, that the physician should, as far as
possible, avoid falling into the error of judging such people too
harshly, since after all on him depends the attitude of society
towards them. It would seem to be quite as important that the
clergyman should occupy an advanced position in this matter. It might
seem that charity could easily be overdone; it must never be
forgotten, however, that it is better that ninety-nine guilty should
escape rather than that one innocent person should be punished.
As a matter of fact, prejudice is much more likely to be against the
supposed criminal than in his favour. While it is often declared that
too many persons, who have done at least material wrong, are allowed
to escape deserved punishment, as our knowledge of mental diseases
increases there is more and more of a tendency on the part of experts
to recognise that for many apparently voluntary actions men have only
a modicum of responsibility. Responsibility is, after all, not the
same in all men, but modified very much by the character of the
individual, by his environment and by the {302} motives which have
come to be the well-springs of his actions. No two men are equal in
their responsibility when there is question of certain temptations to
do wrong. Some men find it perfectly easy to resist allurements to
dishonesty which others can not resist. Some men are perfectly free as
regards their attitude towards indulgence in spirituous liquors.
Others find it almost impossible to resist their cravings in this
direction. One might go through the list of passionate actions and
find this true with regard to every one of them. If this must be
admitted with regard to men who are considered perfectly sane and
responsible, how much more so does it become true of those who are
already somewhat mentally unbalanced?
Unfortunately, the tendency to judge harshly, rather than mercifully,
still continues to be one main reason for the infliction of punishment
where often it is not deserved. Above all the clergyman must be a
leader in this tendency to mercy, and his influence should be felt in
popular education in this regard. It only too often happens that
clergymen are found to be strenuous upholders of the opinion that
right is simply right and wrong, wrong, and that a man who knows the
difference between right and wrong must be considered as responsible
for his actions, no matter what modifying circumstances or mental
conditions may enter into the problem of the decision as to his
responsibility. If the clergyman would but realise how difficult in
any individual case must be such a decision, and how much must be
known with regard to the previous character of the individual, then a
great beginning for the modification of the present over-severe modes
of thought will have been made.
From a theoretic standpoint, it would not be easy to state all that
the physician considers necessary to enable him to make his decision
as to individual responsibility. Perhaps, however, the consideration
of a series of cases that have attracted widespread attention, and
which have been most carefully investigated in all their
circumstances, may present the methods of responsible determination
better than any set of rules. Three presidents of the United States
have been murdered within forty years. The murderers were native-born
{303} Americans. In none of the three cases was there any adequate
motive for the commission of the crime. The assassin in President
Lincoln's case might, it is true, be presumed to have a sufficient
political motive, but no entirely sane man could have thought for a
moment that any good would be accomplished at that time for the South
by the removal of Lincoln. A man of known erratic tendency, with the
craving for theatrical effects deeply ingrained in his nature, with a
personal history not entirely free from even more serious
manifestations of mental disequilibration, and with a family history
of more than suspicious character as regards the mental qualities of
his ancestors, committed the crime. He met his death at the hands of
pursuing soldiers. Such was the temper of the time, that had he been
captured alive he would surely have suffered the formal legal death
penalty. Even as it was, public sentiment clamoured for legal victims
and unfortunately they were found.
It seems clear, beyond all doubt, that in this case complete
responsibility for his action was not present in the assassin himself.
The courts decided later that there had been a conspiracy, but there
has always been the feeling that justice was misled by over-zeal to
find scapegoats for injured public sentiment. There is no doubt that
it is an extremely difficult matter to say what shall be done to the
assassin in such a case. The unfortunate result is as much an accident
as the fatal consequences of any other perverted natural force. An
earthquake may kill its thousands and the inevitable must simply be
accepted. Society may protect itself from the further manifestations
of such perverse individuals by confining the unfortunate murderer for
life, but capital punishment, in the sense of a sanction for broken
law, can scarcely be considered to have a place in the given
conditions.
With regard to the murderer of our second assassinated President we
had the farce of a long-drawn-out public trial of a man who was
evidently not in his right senses. Once more a victim had to be found
to satisfy injured public feeling. Guiteau was condemned to death and
suffered the death penalty. Any one who reads the proceedings of the
trial and who realises the significance of the motive that Guiteau
{304} himself gave for his act, will appreciate that the court had to
do with an irresponsible doer of a material but not a moral wrong.
There were many signs of mental disequilibration in Guiteau's previous
career. It is on these eventually that the expert in mental diseases
must depend in order to enable him to obtain a proper estimate of the
extent of the mental disturbance in any given individual. It may seem
that many real criminals can be defended on this same principle of
finding an inadequate motive for their crimes. There are, however,
certain signs of irrationality not difficult to detect if the previous
life of the individual be carefully scrutinised and these must form
the ultimate criterion as to criminal responsibility.
With regard to the third murderer of a President the case is clear. He
was an ignorant, somewhat conceited individual, but he presented none
of the signs of true mental disequilibration that can ordinarily be
depended on to indicate such a disturbance of the physical basis of
mind as impairs responsibility. He was not entirely without a motive,
which in the mind of a brooding, conceited individual, might seem to
be adequate for the commission of the crime. His sentence of the death
penalty was then in accord with the judgment of the best mental
experts. How society shall protect itself, and especially its high
officials, against such notoriety seekers is hard to say.
The consideration of these cases gives a clear idea of how a physician
endeavours to fill up gaps in his knowledge of the character of the
man, his heredity and environment, as well as his previous actions at
various times in life when under the stress of emotion. It may be
considered that such a weighing of circumstances will serve to excuse
many genuine criminals who eminently deserve to be punished. This is,
however, the assumption of the older generation who considered that if
a man did a material wrong he must be punished for it. It is a
heritage of the day, when even accidental killing was considered to
demand some punishment. At the present time the tendency is rather to
consider only the moral wrong, that is, to calculate responsibility
only for such actions as are committed with due {305} deliberation,
intention, and the knowledge of right and wrong as well as the freedom
to perform the action. The old English legal opinion which declared a
man responsible if he knows that what he is doing is wrong has now
given way in most judicial proceedings to the principle that the man
must not only know that he is doing wrong, but that he must also
realise that he is free not to do that which he knows to be wrong.
That is to say, if he feels himself compelled to the commission of
crime, there is surely an impairment of responsibility. Such impulses
to do wrong without adequate motive occur not infrequently among those
whose mental condition is not perfectly normal, and this must always
be taken into consideration in the ultimate decision as to their
responsibility for their action.
JAMES J. WALSH.
{306}
XXVII
SUICIDES
It is a very difficult problem at times to explain just how a suicide
is due to mental alienation in a person whose intellectual powers
appeared previously unimpaired, yet in most of the cases a knowledge
of all the circumstances and of the individual himself would lead
inevitably to this more charitable view. Most suicides are persons
that have been recognised as paranoiacs and likely to do queer things
for a long time beforehand. Indeed, some of the melancholic qualities
on which the unfortunate impulse to self-murder depends are likely to
have exhibited themselves in former generations. Not long since it was
argued that the regular occurrence of a certain number of suicides
every year--varying in various places, always on the increase, but
evidently showing a definite relationship to certain local conditions
--demonstrate that the human will is not free, since from a set of
statistics one can foretell about how many cases of suicide would take
place in a given city during the next year. As a matter of fact,
suicides are not in possession of free will as a rule, but are the
victims of circumstances and are unable to resist external influences.
The most important feature of suicide in recent years is the constant
increase in the number, the increase affecting disproportionately
young adults. This increase in the number of suicides is no illusion;
it is not due to more careful statistics. It is true that in recent
years, that is to say during the last quarter of a century
particularly, the unsparing investigation by the authorities of all
cases of suspicious death, and their report by sensational newspapers,
has added somewhat to the apparent number of suicides. {307} Families
were accustomed to announce accidental death and have their story
unquestioned, in a certain number of cases, where now there is no hope
of concealment because of the unfortunate publicity that has crept
into life. This increase, however, would account for only a small
additional number of suicides, while the actual figures have more than
trebled in the last thirty years.
This increase has come especially in the large cities. According to
the report of the New York Board of Health, there were 1,308 suicides
in New York City during the decade from 1870 to 1880. During the
decade from 1890 to 1900 there were 3,944 suicides. This increase is
much more than the corresponding increase in population. During the
first decade mentioned there were 124 suicides per million of
population. During the last decade this had risen to 196 suicides per
million. The increase is nearly 60 per centum. The increase is
variously distributed over the different ages. While every five years
from twenty upwards shows a percentage of increase in the number of
suicides committed, somewhat less than the percentage of increase for
all ages, the five years between fifteen and twenty shows an increase
of 106 per centum. In a word the deaths of adolescents from suicide
have more than doubled in the last thirty years.
Towards the end of the last decade of the nineteenth century there was
for a time a cessation of the continuous increase. This occurred
during the years 1898 and 1899. Apparently it was due to the fact that
the occupation of the country with other interests, the war and its
problems, and the fact that an era of prosperity made material
conditions better, and thus gave less occasion for depression of
spirits. During the years since 1900, however, the increase has not
only reasserted itself, but has more than made up for the period
during which suicides were less frequent. The increase during the last
four years is more than was noted during the six years from 1891 to
1897.
The same increase has been noted in European cities. The higher the
scale of civilisation in a city, or at least the greater the material
progress and the more strenuous the life, {308} the higher the death
rate. In Dresden, for instance, the rate is 51 suicides per 100,000
every year. In Paris it is 42, in Berlin it is 36; while in Lisbon and
Madrid it is lowest, being only respectively two and three per 100,000
per year. While suicides are more common among men than women in all
countries, this is not true for certain ages. Between the ages of
fifteen and twenty-five the suicides of women are more numerous than
those of men. The suicides of women are increasing faster than those
of men. Fifty years ago the proportion was five to one. Twenty years
ago it had fallen from three to one. Now it is less than two and a
half to one. The saddest feature of the suicide situation is the
increasing number of the children who commit suicide.
Almost needless to say, children's suicides are without any serious
motives and are usually due to an attack of pique because of a slight
from a playmate, a reprimand at home, a rebuke from a teacher, envy of
the success of a companion, disappointment over a passing love affair,
sometimes a peculiar attachment in the case of weak and morbid
individuals, the manifestations of which are resented by its object,
or are forbidden by parents and guardians. These unfortunate accidents
have become so common now that special care must be taken with regard
to children of neurotic heredity. When in previous generations there
have been the manifestations of lack of mental equilibrium, then
children's mutterings with regard to possible recourse to suicide
should be the signal for the exercise of close surveillance. As far as
possible such children should be kept from the strenuous competition
at school in modern life.
As has been well pointed out there is no doubt that the power of
suggestion and example has much to do with the increase of suicide.
Dymond, an authority in the matter, says, "The power of the example of
the suicide is much greater than has been thought. Every act of
suicide tacitly conveys the sanction of one more judgment in its
favour. Frequency of repetition diminishes the sensation of abhorrence
and makes succeeding sufferers, even of less degree, resort to it with
less reluctance."
{309}
Our modern newspapers, by supplying all the details of every suicide
that occurs, especially if it presents any criminally interesting
features or morbidly sentimental accessories, familiarise the mind,
particularly of the impressionable young, with the idea of suicide.
When troubles come lack of experience in life makes the youthful mind
forecast a future of hopeless suffering. Love episodes are responsible
for most of the suicides in the young, while sickness and physical
ills are the causes in the old. In a certain number of cases, however,
domestic quarrels, and especially the infliction of punishment on the
young at an age when they are beginning to feel their independence and
their right to be delivered from what they are prone to consider
restriction, are apt to be followed in the morbidly unstable by
thoughts of suicide.
The important practical question is the prevention of the fulfilment
of the morbid impulse during these impressionable years. Many a young
person has been saved from suicide at this time to realise the
enormity of the act and to live without any further temptation to its
commission for a long lifetime. As a rule the motive for the act is so
trivial and often so insensate that it is not difficult to make
patients (because patients they truly are) see the folly of their
irrational impulse.