THE NATURE AND TREATMENT OF THE PSYCHOSES OF PRISONERS
Those who still believe in an exclusively materialistic theory of mental
disorder must find it extremely difficult to maintain their doctrine in
the face of the many incontrovertible facts brought to light through
modern research in the field of psychopathology.
The modern trend in psychiatry is distinctly in the opposite direction.
We no longer today insist upon material changes in cells and tissues for
every psychotic phenomenon, but rather endeavor to investigate mental
life, be it normal or abnormal, from the biologic point of view. We are
being constantly confronted with the undeniable fact that whatever may
be the physical substratum of mental disorder, it does not aid us in
understanding the peculiar expression which a given psychosis chooses to
assume. Why it is that one paretic greets us with the exalted mien of
his grandiose delirium, while another spreads about him the gloom of a
depressive delirium--the changes in the pyramidal cells do not explain.
There must be, then, factors other than material ones which determine
this.
Mental life, after all, expresses itself in a series of reactions
destined to result in a proper adaptation to environmental conditions,
and the causes which determine a given reaction may be psychic as well
as physical in nature. Indeed, in the realm of psychopathology we see
indubitable evidence of the predominance of psychic causes of mental
disorder over physical ones, and the subject under discussion here
further emphasizes this.
The problem of the prison psychoses, although extensively discussed in
psychiatric literature in the last half century, is far from being
solved, and for this and many other reasons deserves further attention.
The psychotic manifestations of prison life are of sufficient frequency
to deserve some definite place in our nosological tables; they develop
in a milieu artificially created by society, and if this milieu is
responsible for the production of mental disorder, it is of the utmost
importance, both from a preventative and curative standpoint, to
investigate the causes operative here, and lastly, these psychoses
concern individuals who form one of the most important problems society
has to deal with, and any light which the study of psychotic conditions
in these individuals may throw upon the general problem of crime and the
criminal, should be very much welcomed.
I fully believe that in time the study of the psychotic phenomena
developing in criminals will give us a correct insight into the nature
of the criminal personality and thus aid in the solution of that problem
which baffles criminologists today.
We know that while pure experimental psychology and psychopathology have
aided us in understanding the human mind both in health and disease, we
owe the bulk of our knowledge in this field to the investigations of
Nature's phenomena and experiments. The human mind, the most complex and
intricate organ, lends itself but very feebly to analysis when all its
component parts work in unison, and it is only when through disease it
has become, so to speak, disintegrated into its various units, that a
more ready access to it becomes possible. This is being fully
appreciated both by psychologists and psychopathologists. Mental
medicine, however, if it is viewed from the present-day broad conception
of the term, must not confine itself exclusively to psychotic
manifestations in the strictest sense of the word, but should embrace
within its realm that great mass of unfortunates who populate our
prisons, poorhouses and reformatories. It is now being universally
recognized that the pauper, the prostitute, and the criminal classes are
primarily products of mental defect and degeneracy and as such must come
within the purview of mental medicine. This being the case, the same
truisms which apply to the insane in general must likewise apply to the
above-mentioned types.
We are here especially concerned with criminals who, because of a mental
breakdown, have come under the observation of a psychiatrist, and if we
agree with many eminent criminologists that the present juvenile state
of this science and the ineffective methods of dealing with crime are
due to a lack of proper scientific understanding of that anomalous
species which is grouped under the term "criminal man", why not endeavor
to solve this problem by approaching it from the psychiatric point of
view. If the study of psychopathology has given us such valuable data
concerning the normal mind, why not expect that a similar study applied
to the insane criminal will bring to light some important facts
concerning crime and the criminal in general. It is for this reason that
that large group of mental disorders developing in criminals during
imprisonment which has been included under the term "prison psychoses"
is of special importance to the psychiatrist.
The older extensive literature on this subject, although very
interesting from an historical standpoint, offers very little that is of
scientific value, and it is only within recent years that a more
rational approach to this problem has been attempted. It is easily
conceivable that this branch of mental medicine must have shared the
fortunes of psychiatry in general in its various phases of evolution, so
that in the history of the prison psychoses are reflected the various
views which in their day have dominated psychiatry. At present it is the
school of degeneracy of Magnan and Moebius which is especially concerned
with this problem.
Briefly stated, the exponents of this subject belong in a general way to
either of the following two schools. The one maintains that the mental
disorders occurring in prison differ in no way from those met with in
freedom and that imprisonment at most but lends to them a peculiar
common coloring which in itself, however, is not of essential
importance. The other school takes a directly opposite view. The
followers of the latter maintain that the mental disorders which they
are wont to term "prison psychoses" are products of predisposition plus
external factors. They differ from the true endogenous psychoses in that
they are purely psychogenetic in character, and that their highly
colored and extremely variable symptomatology is nothing more than a
reactive manifestation of a particularly predisposed psyche to definite
environmental conditions. According to them we are not dealing here with
mental disorders whose origin, course, and termination are independent
of the crime and imprisonment, as is the case in the ordinary well-known
forms of functional and organic disorders developing in prison, but with
psychotic manifestations which bear the most intimate relation to some
definite situation, and which are characteristically colored and shaped
by the prison milieu.
As a matter of fact, the population of institutions for insane criminals
divides itself into two distinct and unmistakable groups. On the one
hand we meet with the well-known functional and organic psychotic
entities such as occur in individuals in freedom; we see patients who in
the course of their careers as insane people have come in conflict with
the law either accidentally or because of their insane ideas. In them
the psychosis develops and takes its definitely determined course
independently of the milieu in which the individual happens to be
placed. In the majority of instances they suffer from the various forms
of dementia praecox and progress toward demential end-results in the same
proportion as the general run of dementia praecox cases do, whether or
not they have come in conflict with the law. Occasionally we also see a
case of organic brain disease or manic-depressive psychosis, and in more
frequent instances a case of epilepsy. The other, and according to many
authorities, by far the most predominant group of mental disorders met
with in imprisonment, belongs to the so-called "prison psychoses", and
bears definite, unmistakable ear-marks which differentiate it from the
former group. These are, as we have stated, products of a particularly
degenerative soil plus definite environmental conditions, and are of the
utmost importance both from a purely clinical and an administrative
point of view.
The term "reactive manifestation", as applied here, is a happy one, and
inasmuch as the accidental criminal differs from the habitual criminal
as day differs from night, we will expect a different sort of reaction
to a more or less similar situation in the two instances. To
illustrate:--An apparently healthy and in most instances law-abiding and
non-corrupt individual, as a result of a series of overwhelming and
uncontrollable circumstances, commits murder in a fit of passion. Upon
being arrested and upon the sudden realization of the enormity of his
deed the entire constitution experiences a tremendous shock and reacts
to it accordingly. He falls into a stupor, into utter oblivion of the
world about him, becomes in turn excited and confused, his senses begin
to functionate in a fallacious manner, and he thus succeeds in shutting
out from consciousness, for the time being at least, the entire
unbearable situation. Upon emerging from his stupor he has a more or
less complete amnesia for the deed and its attending circumstances, and
finding himself confronted with accusations, cross-examinations, and
lastly, conviction, he at once sets about, so to speak, to square
himself with the situation. What does he do? He develops a quite
limited, well-organized delusional system in which he finds himself
absolutely innocent, his accusers are the guilty ones, and the entire
situation is nothing more nor less than a well-planned plot to destroy
him. His supposed victim has not been murdered at all, but is living and
secretly active in plotting and scheming against him, the accused.
In this artificially created world he lives with comparative ease, and
has thus succeeded in reaching a proper adjustment to the situation.
The most interesting part of it all is that this so well-organized and
apparently fixed delusional system may disappear at once and the various
false ideas may become entirely corrected as soon as the provocative
agent which is at the bottom of it all is removed. This is a fair
example of what has been termed an acute prison psychosis, and occurs
with considerable frequency among prisoners awaiting trial. Naturally,
these psychoses, being, as they are, psychologically motived, are
extremely variable in their manifestations, but at the root they are all
alike and impress the observer as something entirely different from the
pure endogenous mental disorders. They are all psychically evoked
reactive manifestations of a particularly predisposed constitution to
definite deleterious environmental conditions. Some of the cases
reported in the first paper of this series are good examples of this
type of mental disorder.
We owe our knowledge of these disorders to the contributions of Reich,
Moeli, Kutner, Ganser, Rish and others, authors who, although describing
a more or less identical symptom-complex, have given to it different
names, such as hysterical stupor, Ganser symptom-complex, catatonia of
degenerates, etc. The distinguishing features of this disorder are its
psychic origin, that is, its development in consequence of some strongly
affective experience, and its high grade of impressionability to things
in the environment which may at any time suddenly cause a complete
transition from deep stupor to normal manner and behavior.
The symptomatology consists of an acute delirioid, hallucinatory
episode, usually followed by a more or less complete amnesia which may
go back far enough to include the experience which provoked the
disorder. Such delusional formation as takes place after the
disappearance of the fulminant symptoms may well be considered as part
of the repair process, a mechanism which in most instances reflects the
individual's endeavor to adjust himself to an unpleasant, unbearable
situation, and must not be looked upon necessarily as an indication of
the progressiveness of the disorder.
As we have stated before, complete correction of all delusional ideas
may suddenly take place upon the removal of the causative factor at the
bottom of the entire situation.
As to the treatment of this acute prison psychotic complex
theoretically, we should have no difficulty in deciding this question.
We are dealing with the sequelae of some definite situation, and the
removal of that situation may be, and actually is, in most instances,
sufficient to bring about recovery. When we come, however, to deal with
concrete instances in daily practice, the problem does not lend itself
so easily to solution.
What of the man who upon being arrested following the commission of
murder, develops a psychosis while awaiting trial, or who having been
found guilty of murder develops a psychosis while awaiting execution?
The first question which the psychiatrist is called upon to decide in
many instances is that of malingering. To the lay mind and to the minds
of many of our eminent--but psychiatrically uninformed--jurists the
question of malingering suggests itself at once. To them it is perfectly
evident that this development of a mental disorder, in the wake of a
criminal act, is nothing but a timely preparation for the "insanity
dodge." The clinical pictures presented by the acute prison psychosis
are especially apt to awaken suspicions of malingering in the minds of
the untrained. We see individuals who apparently never before showed any
evidence of mental disorder, and who immediately following the
commission of a criminal act manifest pictures of grave alienation. Many
of them don't know how much twice two is, are absolutely ignorant of the
most elementary subjects, remember nothing of the deed, and most
important of all fashion their deliria in such a way as to entirely
negate the deed, or at any rate justify it.
But why cannot all these manifestations be genuine? Many of us no doubt
recall the effect which examinations have upon certain students. The
emotional accompaniment of the examination, especially the emotion of
fright, causes many a student to forget facts which he knew as well as
his own name, and which he is able readily and fully to recollect as
soon as the examination is over. Are we to assume that these students
are malingering? Decidedly not. Why then should we question at all the
genuineness of a mental disorder developing in an individual who faces
the gallows or a life-long imprisonment? As a matter of fact cases of
pure malingering are among the rarest things which the psychiatrist
observes. Wilmanns,[1] in his study of 277 cases of insanity of
prisoners, found but two cases of simulation, and in a later review of
the diagnoses of the same series of cases, the two cases of malingering
do not appear at all. Bonhoeffer[2] in a study of 221 cases of insane
criminals found 0.5 per cent of malingerers. This is the experience of
everyone who comes in contact with these cases, and there are others who
go so far as to maintain that every malingerer of mental symptoms is
mentally defective.
But let us assume that we have succeeded in convincing those concerned
of the genuineness of the disease at hand; what line of treatment should
be recommended? In the first place, we must remember that the mental
disorder, if it belongs to the group we are discussing here, is the
result of a criminal act, and following in its wake, and that therefore
the plea of insanity as an excuse for the deed must manifestly be
excluded. But may not this type of reaction furnish us an index to the
original personality of the culprit? In other words, should we consider
an individual absolutely normal, if, in reaction to some stressful
situation, he breaks down mentally and develops a psychosis? The
majority of authorities maintain that these individuals are decidedly
abnormal, and that it is only a poorly-knit organism which permits of
that sort of reaction. Birnbaum,[3] for instance, insists that the
possibility of a psychic incitation of a mental disorder is the
criterion of a degenerative soil. This is undoubtedly too extreme a
view, but the more one observes these cases, the more one is inclined to
hesitate in calling these individuals normal in the accepted sense of
the term. Let us assume for the moment that these psychotic reactions
are indices of an abnormal personality. Is this defect of sufficient
import to render the individual irresponsible in the eyes of the law?
This question, I fear, cannot be answered very readily. Looking at it
from a purely juridical standpoint, we must say no; because an
individual is so loosely organized as to break down mentally under a
given stress, does not at all imply that a knowledge of the difference
between right and wrong is excluded. The jurist is willing to concede to
the proposition of a poorly-organized nervous system, a degenerative
make-up, a psychopathic constitution; but if these defects are such as
to manifest themselves in crime, society must be given the inalienable
right to protect itself from such defectives. The result is that either
no extenuating circumstances are considered at all, and the individual
is dealt with in the ordinary way, or he is adjudged insane and
committed to a hospital for the criminal insane, whether or no insanity
exists at the time of trial. Thus we have on the one hand a prison
population which more properly belongs under the regime of a hospital,
while on the other hand, we insist on keeping individuals locked up in
hospitals for the insane, whether or no they show actual psychotic
symptoms. If one of the latter class endeavors to obtain his release by
habeas corpus, a tremendous howl is immediately raised by the public
about the "insanity dodge", the worthlessness of expert testimony and
the unpardonable offense of letting loose upon society a dangerous
criminal. If we stop to consider for a moment, we must admit that in the
great majority of instances, we are not dealing here with dangerous
criminals. The man who as a result of a series of overwhelming
circumstances over which he had little or no control, kills another in a
fit of passion, is not necessarily a dangerous criminal. In the majority
of cases it is fair to assume that such an individual will never again
in his life have to cope with a similar set of circumstances. The great
majority of these people have led, up to that single crime of their
life, an honest, peaceful existence, and the instances of an accidental
criminal turning recidivist are extremely rare.
Society looks on complacently at the repeated sentencing of the habitual
criminal and watches without alarm the never failing phenomenon of how
each successive imprisonment only serves to deprave him more
profoundly; it never considers the danger of letting this type of
criminal loose to prey upon it; just so he has served his just and
legally prescribed sentence. But let the victim of the "insanity dodge"
prejudice endeavor to gain his freedom, and society is at once up in
arms.
Thus the matter stands, and until the public learns to know its
criminals as they actually are, this problem will remain unsolved. The
prognosis of the acute prison psychotic complex is good in the majority
of instances. The removal to a hospital regime usually serves to put a
stop to the process and it is important for the expert witness to bear
this in mind for obvious reasons.
We have thus far discussed the psychoses developing in prisoners
awaiting trial, and we shall now turn to that group of cases which are
sent to us from penal institutions which serve for the confinement of
the convicted criminal.
At the outset we shall endeavor to draw a distinction between the class
of individuals we have just discussed, and that which we are about to
consider now. We have seen that the former is made up of individuals who
in most instances have come in conflict with the law for the first time,
and that the mental disorder which they develop stands in the closest
relation with some definite experience in their life. The patients who
come to us from prisons and penitentiaries on account of some mental
disorder which developed while they were undergoing sentence are in most
instances habitual criminals with a marked criminal career back of them.
They differ so essentially from the preceding group, that what has been
said about the former can hardly apply here.
The first really worthy contribution to this subject was made by
Siefert,[4] the physician in charge of the psychiatric department of the
penitentiary at Halle. He published, in 1907, the results of a study of
eighty-three prisoners who became insane while serving sentences. He
divided his patients into two sharply differentiated groups, the true
psychoses, _i.e._, the well-known forms of functional and organic mental
disorders, and the degenerative psychoses, _i.e._, psychotic episodes
developing upon a soil of degeneracy and which according to him form the
typical prison psychoses. Before we go any further it must be mentioned
that Siefert did not take into consideration the mental disorders
developing in prisoners awaiting trial.
"The true psychoses develop out of endogenous causes, attack and
manifest themselves in the prisoner in the same way as in any
law-abiding individual in freedom. They are not essentially influenced
by changes of environment and there exists no intimate relation between
the coloring of the symptomatology and the influence of the
imprisonment. The degenerative psychoses, on the other hand, develop
upon the well-characterized degenerative soil of the habitual criminal,
and are products of predisposition plus environmental influence. They
stand in the most intimate relation to the deleteriousness of prison
life, and are therefore influenced to the greatest extent by change of
environment."
On studying critically Siefert's work one gains the conviction that the
author not only undertakes to solve certain clinical questions, but
endeavors to investigate the problem of the relation between crime and
mental disorder. Although he paid the strictest attention to the
individual symptoms and described in an excellent manner the manifold
and varying symptomatology of these psychoses, he did not succeed in
isolating a symptom-complex which might be considered as typical of the
degenerative psychoses, and thus deserve the independence of a distinct
clinical entity. Above all he occupied himself with the investigation
and delineation of the various anomalous individualities, the
degenerative constitutions upon which these psychotic manifestations
engraft themselves. Thus he divided his prison psychoses into groups
like the "simple degenerative", "hysterical degenerative", "phantastic
degenerative", etc. Siefert undoubtedly overshot the mark in his
clear-cut differentiation between the various types, but he
unquestionably contributed a most important work on this subject.
Let us now endeavor to illustrate what he means by this degenerative
soil giving rise to these psychoses. As we have stated, the great
majority of them are full-fledged habitual criminals and can be easily
recognized by their "degenerative habitus." They are that indolent,
obstinate, querulent, unapproachable, and irritable class of prisoners
who form the bane of prison officials. Constantly in trouble of some
sort, they are subject to frequent disciplinary measures, which,
however, serve not in the least to improve their conduct. Their
extremely fluctuating mood and emotional instability calls forth a quite
unfounded wild rebellion against the prison regime. They are constantly
after the physician with numerous hypochondriacal complaints, such as a
nervous heart, digestive disturbances, insomnia, etc. In short, they
impress one as something abnormal, something entirely different from
the ordinary prisoner. On this basis, now and then more marked,
definite psychotic manifestations engraft themselves. Here and there one
of them starts to speak of nightly visions, complains about a feeling of
anxiety, speaks of suspicious noises and voices in the vicinity, and
finally makes a superficial, ineffectual attempt at suicide. Others
become suddenly more antagonistic, vehemently assert their innocence,
speak of being the victims of false accusations, etc. Still others
suddenly develop a wild, maniacal state, destroy everything within
reach, become markedly hallucinated, elaborate various persecutory
ideas, and finally have to be transferred to an insane asylum. Here they
soon quiet down, the active symptoms subside without leaving any trace
behind them, insight may or may not be complete. The characterological
anomaly which is at the bottom of the disorder, however, remains, and
any necessity for the application of more stringent administrative
measures may serve to set the entire process aflame again.
Another group of psychopaths who are prone to develop prison psychoses
are those primitive, superficially endowed individuals with a high
degree of auto-suggestibility, a marked tendency to phantastic lying,
and instability of mood, individuals who have always led a sort of
humdrum existence without aim or goal of any kind in view. They drift
very early into a life of crime and vagabondage, become addicted to all
of the vices which cross their path, are markedly egotistical, have no
conception of social life, frequently desert their wives and families,
and a great many of them finally end their days in jails or poorhouses.
Upon being imprisoned they are unable to adjust themselves to the strict
regime, find difficulty in acquainting themselves with the prison
regulations and in consequence have to be frequently disciplined. As a
result they begin to misinterpret things in the environment and see in
these disciplinary measures nothing but persecution on the part of the
prison officials. They become suspicious, seclusive, introspective,
spend sleepless nights, until suddenly, in the stillness of night, they
perceive isolated phonemes. This strengthens their suspicions. They
refuse food, become apprehensive, the hallucinations reach a more
definite character, until finally they manifest a well-marked
persecutory delirium, or may fall into a semi-delirious stuporous state,
show numerous catatonic symptoms, become destructive and untidy, and in
general present a picture very similar to true catatonia.
Removal to the hospital ward frequently serves to put a stop to the
process at once, and often before reaching the hospital for the insane
they show no traces of the acute mental disorder.
The foregoing are types of degenerative psychoses met with in
imprisonment, and there can be no question that the prison milieu is the
etiologic factor here.
To speak here of a progressive disorder to which imprisonment only gives
a characteristic coloring is entirely erroneous. A psychosis which is
definitely brought on by a certain environment and which is corrected as
soon as the environment is changed, must be looked upon as the product
of that environment. That the degenerative soil which permits of the
development of these disorders cannot be looked upon as a basic
disorder, something like dementia praecox, is likewise unquestionable.
These individuals have always shown the same traits of character; it is
these very same anomalies which brought them in their childhood days in
conflict with the school authorities, which later made them inmates of
reformatories, and which finally were at the bottom of their habitual
criminality. Finally, the total absence of progression to more or less
definite end-results excludes the possibility of an organically
determined progressive disorder. A psychosis which develops in
imprisonment and progresses irrespective of the change of milieu is not
a prison psychosis in the sense that this term is here used. The
following cases are illustrative of the type under discussion.
CASE I.--A. F., aged 31 years; admitted to the Government Hospital for
the Insane April 7, 1911. Father alcoholic; died of cancer of liver
and stomach. Mother died of tuberculosis. One brother has been
confined in the Gowanda State Hospital for the Insane for past five or
six years; has always been an excessive alcoholic. One sister, aged
42, has tuberculosis. One of her children died of tuberculosis of the
bones. Another sister is hyper-religious and eccentric.
Patient was born at Olean, New York, in 1871. He knows of nothing
unusual attending his birth or childhood. He entered school at the age
of six, and attended irregularly for six or seven years. He was
usually older than the other children in his class, and was held back
a year in the third and fourth grades. He left school at the age of
fourteen, while in the fourth grade. He then worked in a shoe store,
commencing at a salary of four dollars per week, and receiving six
dollars per week at the time of his separation. As far as is known he
did his work well, as he was promoted during his stay there. Soon
after commencing to earn money he began to indulge in alcoholics. He
became intoxicated one day and set fire to a store, which resulted in
the death of a human being. It did not take much at that time to
intoxicate him--two or three glasses of whiskey being sufficient. He
does not definitely say why he set the place on fire; adding, "Perhaps
I was drunk and did not know what I was doing and maybe I just wanted
to see the fire. I always did like to see fires. Of course, I did not
know that somebody was going to get burned to death." He is not
certain whether he felt sorry for the deed, adding: "Why should I
care? I did not know the man that was burned. He was no relative or
friend of mine; anyway, the people around there said he was no good,
and that it served him right." He was sent to the Elmira Reformatory,
where he remained three years, when he was transferred to the New York
State Hospital for Criminal Insane at Matteawan. He did not like the
Reformatory a bit, they were nagging him all the time. He says it was
like a deaf and dumb asylum; a fellow could not even talk when he
wanted to, and if he did he was paddled for it. The paddling didn't
make him behave, because, he adds: "You can't make a fellow behave by
beating him all the time." He was later transferred to Dannemora,
spending about two years in all, in both these institutions. He did
not like it at the hospital either, because they made him work, and he
hated to work; so finally he asked to be transferred back to Elmira,
which request was granted him. On returning there he was put to work
at brick-laying, but could not get along with the fellow in charge,
the latter was too much of a bully and worked him too hard, so
finally, they shipped him to the new reformatory at Napanoch, New
York. Here he was given employment by the physician in charge of the
hospital, and after ten months of good conduct, was paroled. He says
he behaved well these ten months because he was treated well by the
doctor. Upon being paroled, he returned to Olean and obtained a
position in a tannery where he worked for six months, receiving two
dollars per night. He was drinking heavily all this time, and one
night, failing to return to work, owing to his intoxicated condition,
was discharged. He states that the above is the longest he ever worked
at any occupation since. Shortly after being discharged, he was
arrested in company with several others for robbing a post office. He
was about twenty-three years of age then. He claims that he had
nothing to do with this robbery, and it was just an unfortunate
accident that he got mixed up in it. He was placed in the jail, and
while there the warden tried to poison him. He developed various ideas
that poison was placed in his food, that his stomach was all dried up,
and because he would not eat, he adds: "They sent him over to this
Hospital,--the Government Hospital for the Insane."
He was admitted here the first time on May 29, 1904, on a medical
certificate which stated: "About April 19, 1904, he refused to take
food and claimed to be kidnapped. He had delusions of
persecution--said his head was full of nails and requested that his
brain be cut up. Said the President was his friend."
On August 1st, he eloped while at work in company with another
patient. The record of his mental disturbance at that time is very
meagre, and nothing of a definite nature can be obtained from it.
From here he beat part of his way, and walked part of the way to
Cincinnati, where he had a sister living. One night he heard her
talking to her husband about sending him back to the hospital, so he
robbed them of what money they had in the house, bought a revolver and
returned to Olean. He says he bought the revolver to protect himself
from a certain police captain at Olean. He frequently refers to this
man in a vindictive and abusive manner. States that this police
captain was after him all the time; that whenever any crime was
committed in the city, he was immediately suspected. He was "tired of
this" and bought the gun, intending to kill the police officer if he
should bother him any more. Here he adds: "Anyhow, the cur was killed
afterwards, I am glad of it." After a series of crimes, tramping and
debauchery, during which he suffered from an attack of delirium
tremens, and served a sentence of nine months in a Pennsylvania jail,
he was again arrested for a post office robbery and sentenced to five
years at Leavenworth, whence he was transferred to this institution
April 7, 1911.
As has been stated, he commenced to indulge in alcoholics at a very
early age and has continued this habit during his lifetime. He states
that he had an attack of delirium tremens, during which he received a
severe burn on his left arm by jumping out of a window into a bonfire,
while trying to escape imaginary persecutors. During the years
1903-04, he was addicted to the steady use of morphine and cocaine. He
has led a very loose sexual life; has been infected with gonorrhoea on
numerous occasions, and contracted syphilis several years ago. He has
never married. He intended to marry once, but the girl, he discovered,
was not true to him, so he gave her up. He is a Catholic, attends
church occasionally when at liberty, and was in the habit of going to
confession while at the Penitentiary.
The medical certificate on his present admission stated that on the
night of March 20, 1911, the patient was reported for shouting while
in his cell, claiming that invisible enemies were shocking him with
electricity. There were no symptoms observable before that. Has
delusions of persecution in which invisible enemies are continually
shocking him with electricity and other means and are planning to do
him other bodily harm.
He complained of not being able to sleep and of being tortured. Said
they wired his cell and gave him an electric shock; that he spoke to
the President of the United States and was told that the latter would
visit him.
On March 22d, complained of being choked by supposed workmen. Later he
stated that he had been kidnapped at Erie, Pennsylvania, and expected
the President of the United States to get him out in a few days. He
requested the doctor to send for a priest, complained that they had
failed to send for the President as promised. Said that he had
received a severe shock the night before from the people upstairs, and
stated that they had stored two thousand volts to turn on him.
Following this, he was restless at night and was apprehensive of being
burned to death. Finally he wrote a letter to the President in which
he complained that his life and health were in grave danger; that he
was the victim of a conspiracy, and was being detained illegally at
the Penitentiary, stating that when he was walking peaceably along the
railroad track, he was kidnapped by enemies who had a design upon his
life. He was arrested and while in jail these same officers robbed the
post office and later accused him of the crime. They bribed a witness
to testify at the trial against him and because of this he received an
unjust sentence of five years. He believed that the friends of the
chief of police of his home town, Olean, New York, were paying large
sums of money to the warden of the Leavenworth Penitentiary in an
endeavor to have him electrocuted, and that their efforts had nearly
proven successful, as he had been tortured night and day for the past
month, in fact he was unable to stand it any longer, and if the
President did not come to his relief at once, he intended to take the
matter in his own hands and make short work of the warden. He thought
he was accused of the murder of the police officer who was killed in
his home town, but he insisted that at the time of the murder he was
locked up in jail, hence could not have done this.
The patient continued in this trend of thought and conduct until his
transfer to this institution, April 7, 1911.
On admission here he talked in a coherent manner, was clear mentally
and quite well oriented. He reiterated the story given above,
namely,--that he was kidnapped in Pennsylvania on a trumped-up charge
of post office robbery, was tried by a "phony" court and sentenced to
five years at Leavenworth. Soon after arriving there the warden had an
electrical apparatus rigged up with which he was tortured constantly.
He complained to the doctor about this and begged to be put in a cell
so he could get some sleep as he could not sleep in his cell on
account of these electric shocks. He heard them saying from above that
they were going to torture him. One night they had him paralyzed on
one side.
In an endeavor to explain these persecutions he stated that probably
the railroad police who arrested him were friends of the police
captain at Olean with whom he had had trouble for a long time, and who
was later killed by someone; that probably they blamed him for this
killing, and that for this reason they framed up the charge of post
office robbery against him. He believed that the electrocuting which
he was receiving at Leavenworth was a part of this scheme to get rid
of him, as he knew that the police captain at Olean was a friend of
the warden of the Penitentiary. In giving this recital he was somewhat
irritable and nervous, constantly rubbing his head and face in a
troubled manner. He kept to himself, making no acquaintances with
those about him and was apparently somewhat worried and apprehensive.
He slept well the first night, stating that nobody bothered him. He
stated that he was not insane, that there was nothing wrong with his
mind. When asked why he was sent here, said simply because of a trick,
that he was told that he was coming to the President to secure a
pardon, and instead of this, was brought to this institution. He was
quite unstable emotionally, very surly and irritable, and soon
transferred his persecutory ideas to the officials of this
institution. He complained of having electricity on him; stated that
the warden at Leavenworth rigged up a wireless apparatus whereby he
could send wireless messages to him constantly. Stated that he had
been chloroformed at night and that his body was lined with electric
wires through which electricity was running all the time. He became
very abusive to the physician, stating that the latter was in league
with the officials at the penitentiary to torture him. This state of
affairs continued, with the addition of the delusional idea that the
physician was endeavoring to hypnotize him, until the early part of
September, 1911, when he acquired full insight into his mental
disturbance, realizing fully that the various ideas which he expressed
were delusional, and that he must have been suffering from mental
disorder at the time.
Mental examination revealed no defect, and his knowledge was quite in
accord with his educational advantages. Morally, he was distinctly
defective. Physical examination showed various stigmata of
degeneration, such as asymmetry of the face; large outstanding and
flattened ears; narrow and dome-shaped palate; irregularly placed
teeth; prominent parietal bones; two symmetrical depressions on the
occiput; congenital flat-footedness; and a sullen facial expression.
His arms were covered with tattoo marks. Sense of pain somewhat
diminished. Sympathetic reactions could not be elicited. Wassermann
reaction with blood serum nearly complete positive.
The patient finally recovered from his mental disorder, and on
January 16, 1912, was returned to the penitentiary to serve out the
remainder of his sentence. At this writing, November, 1915, nothing
further has been heard from him.
We have before us an individual who to start with, is badly tainted
hereditarily. His childhood history is indefinite, aside from his
statements of having been usually the lowest in his class at school. He
launched upon an industrial career at a very early period in life and
simultaneously with commencing to earn money he began to indulge in
alcoholics. His industrial career was cut short soon after. He gets
drunk and sets fire to a store, causing the death of a human being.
This, at the age of seventeen. His moral status can readily be surmised
when we remember his reply to the question as to whether he was sorry
for the deed. "Why should I be sorry? I didn't know the man that was
burned." The usual course of the law was taken in the case and he was
placed in a reformatory. He spent nearly six years between that
institution and hospitals for the criminal insane, when he was released
on parole. It is of interest to note here how he reacted to the stress
of confinement in the reformatory. We find that on two occasions during
this period it became necessary to transfer him to an insane asylum. We
shall have occasion to refer to this again later.
If there ever existed in him any chance for reform, the reformatory
apparently killed it, for his life since then has been an uninterrupted
chain of crime and debauchery. He has been a prey to all the vices of
modern civilization; he is a confirmed alcoholic, was addicted to the
habitual use of morphine and cocaine; has been infected on numerous
occasions with gonorrhoea; has contracted syphilis and received a serious
burn during an attack of delirium tremens. In all, he spent eight of the
past fourteen years in penitentiaries, jails, and institutions for the
criminal insane, and has, now, an indictment for larceny hanging over
him. Released from a six years' confinement he finds himself thrown upon
his own resources and is confronted for the first time with the problem
of providing for himself. The poorly-begotten organism, whose start in
life, already deficient in those attributes and forces which are so
essential for an effective struggle for existence and which was rendered
still more deficient by a six years' sojourn among criminals, finds
himself unable to cope with conditions as they exist, and several months
after his release from imprisonment we again find him arrested for
robbery. Being taken hold of by the law does not mend matters in the
least. On the contrary, we see the same tendency to break under the
stress of imprisonment, with the overwhelming burden of an enforced
routine existence, reassert itself as on the former occasion, and in
reaction to the situation he develops a psychosis which necessitates his
transfer to an insane asylum. Placed under the less exacting regime of a
hospital, he soon recovers and avails himself of the first opportunity
for an escape which presents itself. Finding himself again at freedom he
endeavors to find some explanation for his unfortunate position in life
and in the midst of this he discovers that his sister is planning to
return him to the hospital. Even his own sister is against him. He
begins to assume that paranoid view of life which characterizes his
later existence. Now he knows where the trouble lies. The whole world is
against him; no wonder he can't get along; his own sister is trying to
force him back into the hands of his persecutors. His own deficiencies
and incapacities he projects upon the environment. It is the world about
that is at fault; not he. They are after him all the time. He buys a
gun with which to protect himself, and with renewed antagonism against
society in general he defiantly launches upon a career of crime and
vice. Again taken hold of by the law, the old story repeats itself. He
lands in an insane asylum.
Upon an analysis of the content of his psychosis, we find that he
elaborates a story of having been kidnapped in Pennsylvania, upon a
trumped up charge of robbery, taken before a "phony" judge and given an
unjust sentence of five years. The police officers who arrested him were
friends of the murdered police captain at Olean and were hired to do
this job, because he (the patient) was suspected of having had something
to do with this murder. He dreads being placed in the penitentiary
because he knows the warden is likewise against him, being a friend of
the murdered police captain and might perhaps be in league with his
persecutors and take this opportunity of avenging himself upon the
suspected murderer, and sure enough, soon after his arrival at the
penitentiary, the warden has an electrical apparatus rigged up with
which to torture him, etc. His psychosis takes the usual course, he
recovers soon after having been removed from the oppressing environment.
The question arises here, "Are we dealing with a psychosis which
engrafts itself upon the individual without any apparent cause, a
psychosis possessing a course and termination wholly independent of
outside influences, a psychosis having no tangible relation to any
definite situation; or have we here a psychogenetic disorder, a
pathologic reaction of a degenerative constitution to an unfavorable
situation, a paranoid picture developing as an outgrowth of the
individual in reaction to a definite experience?" In other words, are
we dealing here with a case of dementia praecox, or with one of the
degenerative psychoses? If we agree with Stransky[5] that dementia
praecox depends upon an intrapsychic ataxia, that it is the disturbed
cooerdination between the intellectual and affective faculties of the
individual which makes the picture of dementia praecox what it is; this
is not a case of dementia praecox. The acute emotional reaction to all
situations which this man manifests, the development of the psychosis in
consequence of the depth of his feelings concerning the unpleasant
experiences and the entire absence of this important incooerdination
between his feeling and acting, would, in itself be sufficient to
separate his psychosis from dementia praecox. If we agree with Kraepelin
and others that dementia praecox has a more or less definite onset, a
more or less definite course and termination in a dissolution of the
individual's psyche, our case is not one of dementia praecox. Our patient
has had the same attributes of character and personality always. There
is no indication in his life history of a definite onset of a retrograde
process, or of any progression towards dissolution. His psychosis, such
as it is, is the outgrowth of his degenerative personality, and if we
assume this to be true, if we consider the psychotic manifestations of
this individual as a pathologic expression of his anomalous personality,
the question arises--to what extent have his criminal acts likewise been
pathologic expressions of the same underlying degenerative basis? I
believe that the relation between the criminality and mental alienation
of this man is analogous to that existing between two branches of the
same tree. The same degenerative soil which makes the development of the
psychosis possible in one case, expresses itself in crime in another
instance. The factors which determine whether the one or the other phase
will manifest itself, depend largely upon environmental conditions, and
are accidental in nature. The stresses which these defective individuals
meet with in freedom need not have such a strong influence upon them as
to produce a psychosis. The want of moral attributes makes it possible
for them readily to surmount many difficulties by means of some criminal
act, difficulties which in a normal person would require extraordinary
effort to remove. When placed, however, under the stress of imprisonment
where they can neither slip away from under the oppressive situation,
nor square themselves with it by some criminal act, the organism becomes
affected to such a degree that the development of a psychosis is greatly
facilitated. The character of the delusional fabric of these individuals
is such that one can easily find a ready and more or less correct
explanation for it. It is chiefly a compensatory reaction in an endeavor
to make a certain unpleasant situation acceptable.
CASE II.--J. H., aged 37. Admitted to the Government Hospital for
the Insane, March 8, 1909. Maternal grandfather died suddenly from
unknown cause. Was a race-track operator. Father alcoholic. Mother
suffered from vertiginous attacks. There were twenty-one children in
the family, fifteen of whom died in infancy. One brother died of brain
tumor. One sister is neurotic; her eight year old son suffers from
congenital heart disease. Patient was born in Manchester, England. He
was the twentieth child; mother was over forty years old at the time
of his birth. He was an unusually small and puny infant and remembers
using crutches when a child. At seven he was bitten by a dog and
dragged about on the ground for a great distance; when finally
rescued was unconscious for a long time. No further ill-effects.
School life was characterized throughout by truancy and disobedience
and finally terminated in expulsion. At that early period of life he
already showed marked egotism, extreme vindictiveness and an utter
disregard for consequences. The immediate cause of his expulsion from
school was a fistic encounter with a teacher. At the age of eleven,
his family immigrated to this country. He states that he was different
from other boys of his age, did not care for the ordinary childhood
sports, and the only friends he had were a young sister and a dog. He
states that he couldn't get along somehow with the other boys, that he
often thought that the whole world was trying to down him and
persecute him. About that time someone stole his dog. He brooded over
this so much that he finally jumped into a creek, intending to commit
suicide, but was rescued by bystanders. He has made several other
attempts at suicide in later life. In describing these he elaborates
them with a lot of fanciful trimming, dilates on the importance of the
various situations attending them, and how much uproar they caused
among those who knew of them. At the age of fourteen he had a quarrel
with another boy. Upon being reprimanded by the latter's father, he
could not rest until he had obtained a gun and fired at the boy's
father while the latter was sitting at the supper table with his
family. In relating this incident he states with great vanity that he
fully intended to kill the boy's father; he wasn't going to be
insulted by anyone and let it go at that. Here was probably the first
well-illustrated instance of his pathologic emotionalism, the tendency
to a complete dominance of a certain affect. He was committed to some
sort of an industrial school for a year. Upon his release from there
he went to work in a machine shop in his native town. One day a couple
of gentlemen and a lady walked through the shop and stopped in front
of the machine on which he was working. He did not like this, became
angered, picked up the dog which followed them and threw it into the
oil tank which fed his machine. At sixteen he ran away from home. He
gives a history of an industrial career and apparently he had no
difficulty in learning a trade, and it is quite likely that he was a
skilled workman. His entire industrial career, however, is
characterized by an inability to fit harmoniously into the situation
at hand, not because of an intellectual deficiency, but because of the
disharmony between his various mental faculties. His extreme
sensitiveness and emotionalism, his vindictiveness, the total lack of
a sense of responsibility, his impulsive existence, all these, were
always at play in his relations with man. If to these be added his
extreme egotism and vanity, the reasons for his conflicts become
clear. "Here, the foreman thought he knew more than I did." "There, I
did not like the way they were running the business," etc. Among his
occupations, saloon-keeping and professional gambling played an
important role. He finally gave up all attempts at leading an honest
existence and turned to crime. Our record of the man in this regard is
rather incomplete, but according to his record at the Secret Service
Bureau, he was sentenced in 1890 to a two years' term for highway
robbery. In 1902 to three years for counterfeiting; in 1904 to three
and a-half, and in 1908 to six years for the same offense. These
sentences were incurred under various aliases. He married at a very
early age. He says he made up his mind one night to get married and
two days later was married. His conjugal life, like everything else he
engaged in, proved a failure and was characterized by repeated
desertions. He commenced using alcoholics at a very early age and has
indulged excessively all his lifetime. He has had several gonorrhoeal
infections, and has an active luetic infection at the present time.
On May 5, 1908, he was sentenced to a six years' term of
imprisonment. Soon after it became necessary to perform an operation
for appendicitis, and upon recovering he began to complain of having
been cut open and of having had poison put inside of him. The U. S.
Government sent men down to the prison who were threatening to kill
him. He saw detectives from Washington whom he recognized. He was very
apprehensive and refused to submit himself to an examination, and made
homicidal attacks upon the officers. On March 8, 1909, he was admitted
to this institution. His conduct here was characterized throughout his
entire stay by the same attributes of character which were at play
throughout his entire antisocial existence. He was at all times very
emotional. He was very sensitive, becoming offended on the least
provocation, and when laboring under some imaginary grievance his
antagonism and vindictiveness knew no bounds. He was constantly
plotting and scheming some means of inciting a revolt among the other
inmates and took every opportunity to put himself forth as the
champion of the other patients. He was very egotistical and vain and
showed a marked tendency to interpret most trivial occurrences in his
environment as having some reference to him. He was always ready to
endow every incident with a personal note of prejudice. He showed
throughout marked fluctuations of mood. One never knew what sort of a
reception one would meet. He was a pathological liar, was keenly alert
to everything that transpired about him and was always ready to
utilize every incident to his own advantage. He was depraved to a very
marked degree morally. He gave his past history without the least sign
of regret and when questioned concerning the reason of his criminal
life, he objected strenuously to being called a criminal, insisting
that what he did was right. At times he impressed one by his mode of
reaction to various daily occurrences as being as naive as a child
and suggestible to a very marked degree. He frequently threatened to
commit suicide if refused some of his impossible requests and showed a
marked tendency to hypochondriasis and exaggeration of actual ills. On
this basis he developed various persecutory ideas, exclusively against
those who had anything to do with his care and safe-keeping. The
warden at the jail before he came here tried to poison him and took
the opportunity of accomplishing this while he (the patient) was
undergoing an operation. The Government sent Secret Service men down
to watch him and persecute him. Here the physicians are doing the same
thing. They are trying to down him, to make his life miserable for
him, etc. Throughout his sojourn here he was clearly oriented, knew
everything that was going on and failed to show the least indication
of the existence of a deteriorating process. He showed also a marked
tendency to write a good deal of poetry and fiction in which he spoke
of himself as a martyr who had been persecuted and downed all his
lifetime. His stories were of a fantastic, adventurous kind, in which
gambling, shooting, and similar highly melodramatic situations were
enacted. On July 17, 1911, he was returned to prison as recovered.
Another point of interest in this case and one to which I have briefly
alluded before, was his tendency to the exaggeration of symptoms and
to malingering, but the malingering which he manifested was of the
kind that the child manifests in an endeavor to attract attention to
itself and to arouse the sympathy of those about him.
Here again we have before us a kaleidoscopic picture of the life of a
human being who from childhood showed tendencies so antisocial, so
criminalistic, that it is hard to get away from the belief that most of
the attributes which went to make him just what he is, must have been
inherited. Let us take this poorly-begotten organism and follow it
through life. We shall see how its existence has been a continuous round
of conflicts with everything it came in contact. He entered school and
meets with the first obligation, with the first necessity for a
well-regulated, purposive existence. What is the result? Truancy,
disobedience, and finally expulsion--not because of intellectual
deficiency, but because of those same attributes which later served to
put him in the penitentiary. It was the first evidence of his pathologic
emotionalism and vindictiveness. We next see him in an effort to lead an
industrial life, but here, too, everything he does proves a failure, and
likewise not because of intellectual deficiency, but because of a
disharmony, a disproportion, between his various mental faculties. He
could not, somehow, submit himself to any well-regulated existence. His
egotism and absolute lack of the sense of responsibility made it
impossible for him to adjust himself effectively to the world about him.
He next tries matrimony, and the same story reasserts itself. His
conjugal life is characterized by repeated desertions; and thus he
becomes steadily more debased, more depraved, sinks to the level of the
professional gambler and finally even this becomes too strenuous for
him, and he turns to a life of crime. At the age of forty we find him
with a record of numerous arrests, and as far as known, one-fourth of
his lifetime has thus far been spent in jails and penitentiaries. The
characterological anomalies at the bottom of his career came to the
front already in his childhood days. Before completing his fourteenth
year we find him deliberately planning the murder of a human being
because of an insult. His idea concerning that situation has not
changed in the least since then. He now speaks of it without the least
sign of remorse or regret. As a matter of fact, he is inclined to
impress one as being rather proud of that deed, and he cannot see the
criminality of it. The atavistic nature of his act in throwing the dog
into the oil tank is quite evident. Then his attempts at suicide
throughout his lifetime, evidence of a pathologic emotionalism, must
also be remembered. These are a few examples of his mode of reaction to
everyday occurrences in life. Is it at all strange that he has developed
finally into the habitual criminal? On the contrary, it would be rather
strange that an individual with such attributes should turn out to be an
honest, peaceful citizen. He likewise was a prey to all the vices of
modern civilization, and these, as in the preceding case, unquestionably
added to the dissolution of the originally defective organism. We
finally meet with an illustration of the other phase of his mode of
reaction. Following imprisonment on a charge of robbery, he develops a
psychosis which necessitates his transfer to an insane asylum. Brief as
the description of his psychosis has been, it is sufficient to
illustrate that here we are likewise dealing with a psychogenetic
disorder manifesting itself as a reactive expression of a degenerative
constitution to an unpleasant situation. Shortly after his arrest he is
being operated upon for appendicitis and upon recovery elaborates the
idea that the warden of the jail, one of the members of that large class
against whom he has been warring all his lifetime, takes this
opportunity of placing poison in his body. He sees and hears people
around his cell whom he recognizes as Secret Service men sent down from
Washington to torture him. On his transfer to our Hospital he readily
carries over his delusional ideas to the officials here. He is simply
being persecuted by a bunch of anarchists, who are trying to down him
and make life miserable for him.
It has long ago been questioned by psychiatrists whether these so-called
delusional ideas of this class of patients deserve to be endowed with
the value of delusions. Let us not forget that a similar attitude toward
officialdom exists in the minds of criminals enjoying a respite from the
law. It is the officers of the law, society's institution for the
prevention and punishment of crime, that these people have to fear, and
when they speak of being persecuted by those who have their care and
safe-keeping in hand, it is not, necessarily, a pathological
manifestation. The only difference between such paranoid ideas in the
criminal at freedom and the one in confinement is that in the latter
case, coupled with the stress of confinement, the stress of a forced
routine existence, these ideas assume enormous proportions and in some
instances become supported by fallacious sense perceptions. Their
exaggerated self-consciousness, their great tendency to introspection, a
tendency which is very much enhanced by confinement and plenty of
leisure time for such indulgence, and their paranoid attitude toward law
and its officers, makes it possible for them to endow the least
significant occurrence in their environment with a personal note of
prejudice. The least deviation from the normal routine has a meaning to
them, a meaning which is readily interpreted as some evidence of
persecution, of prejudice, etc. The course of their disorder shows so
much evidence of this psychogenetic character that it is impossible to
think that we are dealing with a psychosis which apparently has no
relation to the situation at hand. Every symptom which they manifest
can be traced to some definite cause and can be clearly explained as
being of the nature of a reaction, of a motivated expression to a
definite experience. It is, I believe, unnecessary to enter into a
lengthy discussion to show that we are not dealing here with a case of
dementia praecox, but with one of the degenerative psychoses and we will
consider the criminal tendencies of this individual likewise as
expressions of that same degenerative soil which permitted of the
development of the psychosis. On July 17, 1911, the patient was returned
to the penitentiary to serve out the remainder of his sentence.
CASE III.--P. F., alias H., white male, aged 42. Admitted to the
Government Hospital for the Insane, March 11, 1910.
Father is a chronic alcoholic; one brother a wanderer, has not been
heard from for twenty years; one sister a suicide; one sister left
home at the age of eighteen and has not been heard from since.
Patient was born in England in 1868. Was a healthy child as far as he
knows; no history of spasms or convulsions. Talked and walked at the
usual age. Of the diseases of childhood he had whooping cough, measles
and scarlet fever, from which he apparently made good recoveries.
Entered school at the age of seven; attended irregularly until he was
twelve years old. After leaving school he made an attempt at learning
a trade and worked as apprentice for some time. At fifteen he
endeavored to enlist in the British Navy, but was rejected on account
of palpitation of the heart. In 1884, at the age of sixteen, he joined
the Royal Marines; soon found this to be disagreeable to his tastes,
and wanting to secure his discharge, he stole a suit of clothes off a
dummy with the avowed purpose of being discharged for the offense.
Was arrested, plead guilty, and served a sentence of one month. In
1886, at the age of eighteen, he enlisted in the Royal Fusileers and
deserted therefrom about a month later. He then reenlisted in the
eighteenth Royal Irish Fusileers, shortly after deserted, and then
gave himself up; was court-martialed, dishonorably discharged, and
given a sentence of six months which he served in Brixton's Military
Prison, London. In 1887, at the age of nineteen, under the name of
Henry Sayers, he joined the Welsh Division of the Royal Artillery,
whence he deserted two months later and sold a kit and coat belonging
to another recruit; was apprehended, tried and given a sentence of six
months. In all, he was dishonorably discharged from the service seven
times. In 1892, at the age of twenty-four, he immigrated to this
country. On arriving here he worked about a month at railroading and
then enlisted in the Army, deserted after serving three months, and
crossed the Canadian Border. He subsequently returned and gave himself
up to a sheriff, was court-martialed, dishonorably discharged, and
given a sentence of one year and a half. After being released he
resumed his nomadic existence but in a more pronounced manner. Since
1895, he has had no definite occupation, subsisting on begging,
stealing, and peddling minor articles, chiefly on the two former. He
has spent most of his life since then in penitentiaries and
workhouses, and when at liberty, in cheap boarding-houses and
missions. As far as he can recall he has been arrested twenty-two
times for vagrancy since 1895, served four years at Moundsville and
Atlanta for robbery, and six months for theft. He commenced to indulge
in alcoholics at a very early age and has been an excessive drinker
all his life. Has been intoxicated on numerous occasions and has had
delirium tremens twice. In 1897 he indulged in opium smoking for
thirteen days and in 1904 sniffed cocaine for a similar period. On
three or four occasions in his life he has had sexual experiences
with men and there is a definite history of inversion. He has been
married twice. His conjugal life with his first wife was a very
unhappy one. He attributes this entirely to his own fault. There were
three children from this union, all of whom died in infancy. He left
his first wife without obtaining a divorce from her and subsequently,
in 1898, married again. This union was happier than the former one.
His second wife, however, died in 1905. There were no children from
this union. He acquired gonorrhoea and syphilis in 1899. In 1907 he
prepared an elaborate attempt at suicide, purchased a dagger for this
purpose, and set June 13th for the date. He was, however, arrested
shortly before this and thus his plan was frustrated. He stated that
it was not disgust of life that drove him to do this. He simply had a
desire to see whether he had the nerve to execute such an act. On
February 2, 1910, was arrested for vagrancy and begging, and given a
sentence of 180 days in the workhouse. While in his cell he attempted
suicide by inflicting superficial cuts over the praecordium, wrists and
calves of his legs with a piece of broken table knife. These were very
insignificant in nature. While confined in the workhouse he developed
various fallacious sense perceptions, saw visions of weird and
fantastic nature, and frequently these would take on a religious and
sexual coloring--he would see nuns' heads. He also developed auditory
hallucinations and would hear voices of a disagreeable nature. He was
subject to peculiar sensations as though there was a wire framework
inside him which made him squirm. This necessitated his transfer to
this institution.
On admission he was well-nourished, but prematurely gray. He had
numerous tattoo marks on his body; on the right forearm a woman in
tights and the head of another; on the left forearm initials U. S.,
flag, ship and cross; over the dorsum of left hand a star, and a band
across the wrist. His vision was impaired to some extent; otherwise
negative. Aside from a futile attempt at suicide which he made shortly
after admission, his conduct has been excellent. He has never been
known to become involved in altercations or quarrels with his fellow
patients and has obeyed fully the rules and regulations of the
Hospital. He was somewhat circumstantial during a lengthy
conversation, but in a superficial interview he made quite a natural
impression. He was clearly oriented and showed no memory defect. His
answers to the intelligence tests failed to show any intellectual
impairment. His emotional tone was unvaried. He was always very
polite, courteous and optimistic, and very popular with the
attendants. He willingly assisted with the ward work at all times, was
keen and alert, fully cognizant of everything that transpired about
him. He spent his time reading and rarely associated with his fellow
patients, whom he considered below him intellectually. He believed in
reincarnation, and thought himself to have been in a former being
Pharaoh of Egypt and the Earl of Warwick. He had tactile, auditory and
visual hallucinations of a religious and sexual coloring. These were,
however, transitory in type and perhaps better called
pseudo-hallucinations, as he was able to bring them on and cause their
disappearance at will. He was frank in his statements and discussed
the various ideas without hesitation. He was inclined to write a great
deal, especially poetry of the waste-basket variety, and considered
himself quite proficient in this respect. On February 2, 1911, he
appeared before the Staff conference where the advisability of
granting him parole of the grounds was considered. Upon being refused
this privilege he again attempted suicide by making several
superficial cuts across the wrists. These were quite insignificant in
nature. At the present writing the patient, I am told, if anything,
had improved somewhat. At any rate he shows no intellectual impairment
nor evidence of any progressive mental disorder. Patient was
eventually discharged on April 7, 1915, as unimproved and went to work
in a steel-plant in the District of Columbia. He soon, however,
reverted to his old alcoholic habits, came in conflict with the law
and was sentenced to the workhouse. While his strictly psychotic
symptoms subsided it is quite evident that the original defective
constitution which has been responsible for all of his past
difficulties has not improved.
Here is another individual who started out in life with a heavy
hereditary burden. His early childhood, as far as can be determined,
was normal. He entered school and here met the first obligation. He
wavered, showed a tendency, that early, to be unable to lead a
well-regulated life and in consequence his school attendance was
irregular. The next difficulty he met was in attempting to learn a
trade. He soon found this too strenuous and sought an environment less
exacting in nature, and at fifteen we see him endeavoring to enlist in
the Navy. This is probably the first indication of his "wanderlust."
He was rejected, and after another year's effort to get along in his
immediate environment, finally succeeded in entering the Navy. Soon,
however, he found out that Navy life was not what he had pictured it
to be. It, likewise, was too exacting. He had to live up to prescribed
rules, obey orders--things to which he could not reconcile himself,
and in consequence failed of a proper adjustment. He knew he could not
stand it, he must get out. He must seek something more suitable,
something less exacting. In looking for a way out of the situation he
availed himself of the first opportunity, stole a suit of clothes with
the avowed purpose of being discharged for the offense. Here is the
starting point of his criminal career. He did not reflect upon the
consequences. He knew he must gratify his desire to get out of the
Navy, must do it at any cost, and yielded to temptation. This yielding
to temptation, this lack of power of resistance, characterized his
entire life. He yielded to every vice that crossed his path; he stole,
he drank, he became a morphine habitue, he sniffed cocaine, acquired
gonorrhoea and syphilis in his promiscuous sexual trends, and lastly
yielded to sexual perversion. After having served his first sentence
he was released and again found himself thrown upon his own resources.
He had not, as yet, reached the stage of the habitual criminal with
the utter disregard for property rights, nor had he reached that
nonchalance of the hobo, whose philosophy rests upon the dogma that
the world owes him a living, that tomorrow will provide for itself
somehow. He began to yearn for the service again. There, at least, he
was provided with shelter and food. There, at least, he did not have
to worry for the tomorrow. He entered the Army, deserted, re-entered,
deserted again, and kept this up until he was dishonorably discharged
seven times. He could stand it just so long. His lack of stability,
his inability for any continuous purposive effort, made him slip from
under the stress. He has less dread for the future now. He was
beginning to acquire that naive philosophy that somehow the world
would provide for him. We next hear of him across the ocean. Here his
"wanderlust", his love of adventure, reasserts itself, but somehow he
did not fit into existing conditions, and unable, because of his
particular organization, because of his disequilibrated mentality, to
create for himself a suitable environment, his existence continued to
be an unbroken chain of conflicts, of contradictions, and of failure.
He finally tried matrimony, but here, too, he soon felt the
overwhelming burden of duties and obligations. He was not assisted in
sustaining these by any moral sense, by any paternal feelings--and
after a more or less continuous struggle to cope with the situation,
left wife, situation and all. He realized subjectively that he and his
wife were not congenial. As a matter of fact, his entire life has been
a continual round of uncongenialities, of inability for a proper
concourse with men and things in the world. Throughout his life his
ego occupied the center of the stage. It is he that has to be
satisfied first. After leaving his wife he resumed his nomadic
existence and sometime later married again. But by this time he was a
full recidivist, as well as an accomplished hobo. The nomad was no
longer able to adjust himself to a communal existence. Besides, it
required effort. He was expected to provide and he could not be
expected to do anything. Fate was in his favor--his wife died. It must
not be forgotten that by this time he had made full use of the kind
oversight of the law. He had been arrested innumerable times, he had
breathed the atmosphere of the workhouse and partaken of the
penitentiary menu. The once unfinished product had been shaped and
polished by the machinery of the law and order of our modern
civilization so that all dread and fear of punishment had lost its
value with him. At last the organism which was originally begotten
from decayed stock, which had been tossed and knocked about through
its entire existence, and preyed upon by all the vices that modern
civilization affords, began to falter and shake. He developed a
psychosis. I shall not enter here into an extensive discussion as to
the diagnosis of the disorder. The total absence of any indication of
progression in this man's mental disorder, the pliability of the
various delusional ideas and hallucinatory experiences, his perfect
control over them in the matter of bringing them on and causing their
disappearance at will, speaks sufficiently against dementia praecox.
CASE IV.--A. W., colored, aged 28. Mother suffers from neuralgia and
headaches; one sister died of pulmonary tuberculosis. One brother is
now serving a sentence at Moundsville Penitentiary for assault and
battery. Another brother has been frequently arrested for various
offenses.
Birth and childhood of patient apparently uneventful. During childhood
fell from a fence following which he was unconscious for some time.
Entered school between the ages of seven and eight, and attended
regularly for about two years, when he became unruly and
ungovernable--would play truant on frequent occasions, and finally
left school before finishing the fourth grade. He worked around home
for a little while, and was arrested the first time when eleven or
twelve years old, for assault. At fourteen he was again arrested for
some minor offense, and shortly afterwards was sentenced to one year
in jail. On August 20, 1902, at the age of eighteen was arrested for
carrying concealed weapons and discharging them in the street, for
which offense he served five months in jail. March 3, 1903, sentenced
to serve thirty days for larceny, and on the same date was further
charged with disorderly conduct, for which he was given fifteen days
in the workhouse. May 1, 1903, he was sentenced to sixty days in jail
for petty larceny; July 18, 1903, charged with fornication, but charge
was withdrawn. August 31, 1903, sentenced to thirty days in jail for
being drunk and disorderly, and committing assault. November 1, 1903,
sentenced to fifteen days in the workhouse on a charge of disorderly
conduct. November 17, 1903, sentenced to twelve years for assault and
highway robbery. He commenced using alcoholics at a very early age,
and has indulged heavily since then. He was admitted to the
Moundsville Penitentiary, December 13, 1903, where he remained until
July 4, 1908, when he was transferred to Leavenworth. His record at
the penitentiary is a very bad one, he was frequently punished for
various offenses and showed a constant tendency to disobey rules and
get into altercations with fellow prisoners. He was in solitary
confinement several times, and forfeited almost all of his good time.
Frequently became mildly excited, singing, shouting, praying and
cursing in the most irrational manner. This state of excitement
persisted unremittingly for seventy-two hours on one occasion. He
declared that his lungs were rotting with tuberculosis or some other
foul disease, and that he was suffocating. He persisted in exposing
himself in a nude condition and refused nourishment.
He was admitted to the Government Hospital for the Insane,
December 24, 1909.
Physical examination showed him to be a well-developed, healthy negro.
Both deep and superficial reflexes exaggerated; ankle clonus both
sides; hyperaesthesia of abdomen and face. He stated that two or three
months prior to his admission to this Hospital he became suspicious of
his food; had a burning in his stomach after eating; believed that his
health was failing him; his breath became short; voice weak and lungs
rotting. Early in December, 1909, he believed that he had been
chloroformed by the prison officials for five days; he was not certain
how this was done but believed that it might have been poured through
the keyhole. During this period he sang like a graphophone; voices
said "move his head", and his head would move itself. When his eyes
were open he saw nothing unusual but when they were shut he could hear
them operating a machine on his body; they were pumping his stomach,
and he became a skeleton. This was done to him through prejudice; did
not know who was prejudiced against him, but at the prison they know
all about it. Said he had not slept a wink since his admission to the
Hospital; his breath is short; he has pains around his heart, but
thinks he is getting better now.
He was a negro of limited mental capacity and possessed very little
acquired knowledge. He was clean and tidy in his habits, keenly
interested in his environment, and well oriented in all spheres. He
lacked insight into the nature of his trouble. Attention could be
easily gained and held; he comprehended well and readily, and showed
no memory defect. There was a very marked tendency to hypochondriasis
and exaggeration of actual ills. Soon after admission the active
symptoms of his disorder disappeared, and he gradually acquired an
adequate amount of insight, realizing that he had been insane. His
conduct, at first orderly, now assumed the same character as that at
prison. He frequently became involved in altercations with other
patients and on several occasions manifested decidedly vicious
tendencies. He was almost absolutely unamenable to the Hospital
regulations and on that account had to be frequently reprimanded. He
incited the other patients in his ward to all sorts of misdemeanors,
and when not having any complaints himself, would fight the other
patients' battles. He remained clearly oriented throughout. He was
decidedly deficient morally--could not see where his life had been an
unsocial one, and did not even promise to lead a better one in the
future.
Here, again, we see disease and crime rampant in the family history of
a man who himself began to manifest criminal tendencies at a very
early age. His school career is characterized by truancy, and he never
made an effort at an industrial career. At the age of eleven or
twelve, we already find him arrested for an offense against the
person, and before having reached his twentieth year he has received a
penitentiary sentence of twelve years. His psychosis is unquestionably
one belonging to that large group developing on a degenerative basis,
the same soil which is at the bottom of his criminal career. What his
future life is going to be may readily be surmised; he has not yet
reached his thirtieth year--and by turning him loose at the expiration
of his present sentence, society adds only another parasitic and
infective organism to gnaw at its roots. It would be indeed ridiculous
to expect the boy who at the age of nineteen was placed in the
environment of a penitentiary--the hot-bed of crime--to be turned out
a better man after having spent twelve years there. Something over two
years has elapsed since the original publication of this paper and I
am able to furnish some additional data concerning this case.
Upon the expiration of his sentence we were obliged to discharge the
patient because he showed no symptoms of mental disease, and in
consequence we had no authority for holding him in a hospital for the
insane. He was discharged in March, 1912. In October of the same year
he was again arrested, charged with assault with a dangerous weapon
and received a seven-year penitentiary sentence.
There can be very little doubt as to what his future career will be
following this second penitentiary sentence.
CASE V.--W. A., white male, aged 36 on admission to the Government
Hospital for the Insane, January 18, 1911. Father was an alcoholic;
mother neurotic, one sister insane, one uncle suicide. Mother enjoyed
good health during her pregnancy with the patient, but birth was an
extremely difficult one.
Patient learned to talk and walk at the age of five, when he was
severely scalded which necessitated his confinement to bed for a long
time. Entered school at the age of seven and attended for about eight
years, reaching the 6th grade. He experienced no difficulty in
learning but played truant on frequent occasions. His industrial
career constitutes an uninterrupted chain of failures. He was
frequently discharged for various offenses and quarrels with his
associates. He commenced to indulge in alcoholics at a very early age
and has been an excessive drinker all his life. Married in his
twentieth year and managed to live with his wife for six years, when
she left him on account of infidelity, non-support and drunkenness.
One miscarriage and one apparently healthy child were the results of
this union.
He came in conflict with the law for the first time at the age of
twelve or thirteen for some offense against the person. We have an
incomplete record of his criminal career, but this can easily be
surmised when we take into consideration that part of it which we do
possess. Between March, 1903, and December, 1910, he was arrested
thirteen times for assault, twenty-eight times for disorderly, and
drunk and disorderly, twice for housebreaking, once for petty larceny
and twice for vagrancy. Habitual drunkenness, destruction of private
property, and depredation on house furniture, add to the list of
charges against him. During this period he served a penitentiary
sentence, was tried for murder, and acquitted on a second trial on a
plea of self-defense, and on four different occasions, was ordered to
be examined mentally. Following a debauch, during which he was
arrested three times for assault, he developed a mental disorder in
jail while awaiting trial, which necessitated his transfer to the
Government Hospital for the Insane.
He developed the idea that someone was always around him looking for a
chance to kill him. Continually heard strange voices and noises. Was
very nervous and irritable.
The records accompanying him stated that for years he had had a
particularly bad and dangerous temper. That he had had several
previous attacks of mental disorder; had repeatedly committed
assaults, and was found not guilty of murder seven years ago--an act
of insanity. Had been arrested by the Washington police about
seventy-five times.
His mental disturbance soon cleared up, and on admission to the
hospital he was absolutely free from any psychotic manifestations.
He was a well-developed man of average intellectual attainments. He
was somewhat unstable emotionally, and his promises to lead a better
life in the future were usually accompanied by a good deal of crying.
He was a monumental liar, and although endeavoring to impress the
examiner with the idea of being quite remorseful about his past life,
it was clearly evident that his moral status was a very low one and
that his promises and resolutions were merely brought forth to aid him
in securing his freedom. He was extensively tattooed and showed
remains of an old syphilitic lesion.
Upon his release from the Government Hospital for the Insane, he was
given a year's sentence in the workhouse, and the Press has been
reporting frequent misdemeanors performed by him in the workhouse.
This case is interesting only in so far as it illustrates
exceptionally well the role of alcoholism in the habitual criminal. It
is, however, very difficult to decide whether the alcohol should be
considered here the cause of the man's degeneracy or its result. It
would appear that whatever injurious effect inebriety had upon this
man, and unquestionably it had, he owes his anomalies of character to
causes over which he had no control. We find that his father was a
chronic alcoholic, his mother a neurotic, a maternal aunt insane, and
an uncle a suicide. That these pathological traits in the antecedents
left their impressions on him cannot be doubted for one minute. He was
abnormal before environment and personal habits had had time to make
themselves felt. He, too, oscillated between penal institutions and
the Hospital for the Insane all his lifetime. That the same
degenerative basis lies at the bottom of both his moral and mental
alienation, cannot be doubted. Here, too, we are able at this date to
furnish other additional information. The patient was eventually
discharged from the Hospital for a similar reason as in the preceding
case, and in spite of all his promises and new resolutions was
readmitted to the Hospital on October 13, 1913 with an attack of
delirium tremens.
Let us endeavor to see now in what respects the above individuals
simulate one another, and whether this similarity is of sufficient
import to warrant the grouping of them into one category. Commencing
with the family history we find disease and crime manifest in the
antecedents, either direct or indirect, of all of them, that in all
probability because of this, not one of these unfortunates was brought
into the world with a sufficient impetus to carry him successfully to
his goal. In every instance we find that the characterological anomaly
became manifest already during their school career. It was the
persistent truancy, disobedience and antagonism to submission to a
well-regulated existence and not so much the incapacity to learn, which
distinguished them from the other children in school. The same
attributes of character which were at the bottom of their conflicts with
the school authorities brought them into the hands of the police
authorities soon afterwards. The contact with the outside world soon
served to bring out other pathological traits of character. We now see
them manifest a pathologic emotionalism, an unbounded egotism, a
relentless vindictiveness and an apparently total disregard of
consequences. Frictions with the surrounding world, which a normal
individual meets in an ordinary manner with a view towards an efficient
adaptation to existing conditions, were reacted to by them in a
distinctly antisocial manner, with methods entirely void of
consideration of the rights of others, an attribute so essential for a
proper concourse with man. Thrown finally upon their own resources, when
they had to rely for their existence upon some industrial pursuit, we
find them lacking the most essential prerequisite for the efficient
struggle for existence--definiteness of purpose, and continuity and
persistence of effort. We find them leading a harum-scarum existence,
drifting from place to place, and from occupation to occupation, never
able to remain at any one undertaking for any length of time.
The next features which stand out prominently in the lives of these
individuals are their recidivism and the fact that every one of them
came under the observation of an alienist on one or more occasions in
his life. What is at the bottom of all this? We cannot, of course, deny
the very evident fact that these individuals differ from normal man and
that this difference is due to their inferiority. But what characterizes
this inferiority? Is it the lack of something which normal man
possesses, or is it rather a disproportion, a disharmony between the
various individual mental faculties of these individuals? In other
words, is their inferiority a quantitative or qualitative one? Taking
pure intelligence into consideration we find that they show no
deficiency in this particular sphere. On the contrary, most or all of
them show a degree of shrewdness and keenness which absolutely precludes
the existence of an intelligence defect _per se_. Their recidivism is
not due to an inability to distinguish between right and wrong. They
know very well what is and what is not right, at any rate, as well as
the average person, but they feel decidedly different from the average
person about this distinction. They are what they are because of a
discord, a disproportion between their various psychic attributes. The
exaggerated egotism, which is so common to these individuals, serves to
establish a pathologic degree of self-consciousness. This in turn makes
them feel with an extraordinary keenness the everyday frictions in
life, and now the pathologic emotionalism comes into play and being
unsupported by any sense of altruism and morality they give way to their
feelings in some criminal act. Their pathologic vindictiveness should
also be mentioned. A sustained real or imaginary injury can never be
forgotten by them.
These, in brief, I believe to be the characterological anomalies which
distinguish the individuals herein reported from normal man and which at
the same time are sufficiently common to all of them to justify their
segregation into one distinct group of criminals.
I shall not enter here into a discussion of what part, if any,
environment played in the shaping of the lives of these individuals, for
several reasons, chief among which, however, is the fact that I have not
had the opportunity of investigating thoroughly the environmental
conditions in which they grew up and am therefore unable to evaluate
properly this phase of the question. The fact, however, that my cases
were culled from various sources and that the anomalous traits
manifested by them were already present at an age when environment could
hardly have had any lasting influence upon them, leads me to believe
that it is heredity that is responsible for the major portion of this
anomalous product. However, we shall leave this question to the decision
of the practical eugenists. Personally I fully believe that we are
dealing here with a type in which heredity plays an important role. I
fully believe that these individuals were always the same as they are
now and that the probabilities are that they will always remain so.
Assuming then, for the moment, that we are correct, the question
arises:--"Has society dealt with these individuals in a proper manner?"
This question must be answered decidedly in the negative. I will not
enter here into an extensive discussion of a system of penology which
might be specifically applicable to this class of individuals. I can
only agree fully with the current opinions of eminent criminologists on
this subject.
At the 1911 Congress of Criminology and Anthropology at Cologne, the
following resolution among others was adopted:--"Hardened and
professional criminals, recidivists, who present a great danger to
society must be deprived of their liberty for as long a time as they are
dangerous to the mass. Their liberty should be as a general rule,
conditional."
Archibald Hopkins, Esq., has been recently quoted by Gault as
follows:--"The Head of Scotland Yard, in London, said not long ago that
nine-tenths of the serious crimes there were committed by men who had
served one or more terms of imprisonment and who might be regarded as
belonging permanently to the criminal class. His judgment was that if
they could be eliminated from such a situation, violation of the law
would be diminished to less than a third of what it has been. Why cannot
this be done? Let the Courts be clothed with power, after two or more
offenses, in its discretion, to pronounce a man incorrigible, who shall
be sentenced for life, to whom no pardon shall issue. By an arrangement
between the general government and the states, a colony could be
established, say in the Island of Guam, where escape would be
impossible, and where, under military guard, convicts could be made to
earn their own living. Surely society has the right to protect itself
from these incorrigibles, who are released only to prey on it again.
They also are the class who rapidly produce their kind, and at present
society puts no obstacle in the way.
"It is exactly as if, instead of forming colonies to which all
lepers are compelled to go and remain, we permitted them, after a brief
term in the hospital, to go where they please and to marry and produce
more lepers. The incorrigible criminal is worse than the leper because
he deliberately and purposely defies society and spreads his contagion.
It can hardly be questioned that the permanent segregation of the
professional criminal class would very greatly diminish crime, nor can
it be questioned that society has the right to adopt such a measure of
protection, nor that it would not be entirely practicable." (See Journal
of American Institute of Criminal Law and Criminology, April, 1912,
pp. 821 f.)
The only argument, and a very weighty one it is, which can be raised
against the foregoing proposition, is whether the incorrigible criminal
is sufficiently characterized by such unmistakable features as would
enable us to recognize him when we see him, and thus justify his
permanent isolation from the community. I believe he is, and the cases
here reported are fair representatives of that class. Another problem
which presents itself is: "Where shall we put the incorrigible
criminal?" If we agree that he owes his criminality to causes over which
he has no control and that the crime here is the outgrowth of a
degenerative personality, a personality which is distinctly abnormal,
it would seem that he belongs in a hospital rather than a penal
institution, but is this unequivocally so? It is unquestionably true
that these individuals are abnormal, that without actually being insane
they evidence from their earliest childhood a more or less distinct
deviation from the normal; they may therefore be considered as
"border-line cases," _i.e._, cases which deviate from normal man and
incline toward the insane through numerous gradations. As soon, however,
as their abnormality manifests itself in distinct incorrigible
antisocial tendencies, the right of society to protect itself from such
an element must be considered. When free from actual psychotic
manifestations (which very easily engraft themselves upon this
degenerative soil) these individuals do not belong in a hospital for the
insane. Here they serve only as a very troublesome and disturbing
element, and wield an undesirable influence over many easily
impressionable insane patients. They do not belong in a general penal
institution because of the very deleterious influence they exert on the
accidental but uncorrupted convict with whom they come in close contact
in these institutions. It is my opinion that these individuals, forming
as they do a distinct species of humanity, should be segregated into
colonies especially designed for them, where under proper medical
supervision, they should be made to earn their subsistence by means of
some useful occupation. It is very obvious that an indeterminate
sentence is the only rational way of approach to this problem and this
should be supplemented by the vesting of the parole power in the hands
of a board composed, not exclusively of members of the legal profession,
but largely of physicians, and particularly those trained in
psychopathology.
The foregoing cases, while distinctly abnormal mentally, owe their
recidivism to a qualitative rather than a quantitative defect.
Since the original publication of this paper, I have had occasion to
observe a number of recidivists in whom the defect was essentially a
quantitative one, _i.e._, patients ranging in intelligence all the way
from idiocy to moronism.
The following case is a good illustration of this type:--
R. W. (colored) was admitted to this Hospital for the first time from
the District of Columbia Reform School on February 8, 1898. He was at
that time serving a sentence for housebreaking. He was twenty years
of age at that time and examination showed him to possess the
intelligence of an imbecile. During his sojourn here he had several
maniacal outbreaks, but recovered from these and was discharged into
the care of his parents on November 23, 1898. Sometime in 1900 he was
again sent to the Reform School and was readmitted to this Hospital on
November 17, 1900. He suffered at this time from an acute
hallucinatory episode from which he soon recovered and was allowed to
go out on a visit on February 20, 1901. He never returned from this
visit but on July 23, 1902, was sentenced to twelve months
imprisonment for larceny. While serving this sentence he was admitted
to the State Hospital for the Insane at Norristown, Pennsylvania,
where he suffered from an acute maniacal attack with persecutory
delusions. He was discharged from that institution, by order of the
Court, on September 29, 1903. On January 1, 1904, he was arrested for
housebreaking and sentenced to three years imprisonment at the United
States Penitentiary at Moundsville, Virginia. From the above
institution he was admitted to this Hospital on May 8, 1905,
suffering from an acute maniacal attack. He soon recovered again and
was discharged on August 18, 1906, with a diagnosis of imbecility with
recurrent mania. He was readmitted here October 3, 1907, and
discharged April 1, 1909. On January 23, 1910, he was given a two
months workhouse sentence for petty larceny. On September 7, 1912, he
was again sentenced to four years in the Penitentiary for grand
larceny, from which institution he was readmitted here on January 19,
1915.
I shall not enter into a detailed discussion of this case. It is simply
quite illustrative of the absolute necessity for permanent segregation
of mental defectives.
When some of this clinical material was first published in 1912 it met
with very gratifying recognition at the hands of those who were
interested in criminalistics.
I wish to take this opportunity of expressing my particular appreciation
of Dr. Healy's kind words of approbation and encouragement.
We all must agree that the first essential step towards a better
understanding of criminal types consists in a thorough study of the
criminal individual, such as is reflected, for instance, in the very
excellent book by Healy on the "Individual Delinquent." Such studies
have thus far, however, with but rare exceptions, not been made at the
proper source,--that is, in the criminal laboratory, the penal
institution.
The work which is being done with the juvenile offender is, of course,
very important and very valuable; but in order that this work may be
checked up scientifically it must be supplemented by thorough
catamnestic studies of the juvenile offenders. This, I believe to be
the only rational way of approach to the problem.
This will in time, I believe, furnish us data concerning the criminal
which will enable us to evaluate in a correct manner the various traits
and characteristics of the juvenile offender and thus enable us to
render a correct prognosis in a given case. Once we shall reach a stage
in the science of criminology when we shall dare to say of a juvenile
offender, as we now unhesitatingly say of the leper, "Here is a human
being who will always be a danger to his fellow-man and, therefore,
should be permanently isolated from his fellow-man", the problem of
recidivism will be solved.
We cannot, however, arrive at a proper conception of the nature of a
juvenile offender by merely studying a cross section of him at any given
moment of his life. In order to understand man, especially abnormal man,
we must study him in a longitudinal section; we must note his mode of
reaction to experiences in everyday life, under all manner of
conditions and circumstances; we must investigate the motives and
desires which prompt his conduct; we must find out how effectually he
adapts himself to the environment in which he happens to be placed and
in how far he is able to modify the world about him so as to make it
subservient to his needs and wants. The same problems which confront
criminology today, psychiatry had to face some years ago. In order to be
able to rationally and scientifically deal with the insane the
psychiatrist found it essential to establish certain criteria which
might enable him to tell, with some degree of certainty, what the future
life of a given insane person will be. In the last analysis it is this
same thing which we are aiming to attain in our dealings with the
criminal. The problem which is constantly before us in dealing with
juvenile delinquency is what might be expected of the future life of the
juvenile under consideration and what must be done towards directing his
future into proper channels. So, after all, it should be our aim to
establish certain criteria by means of which we should be able to render
a proper prognosis. That we possess no such criteria at present can be
denied by no one.
As I have already stated, psychiatry had to face the same problems. With
the advent, however, of the Kraepelinian school these have in a great
measure been solved. Kraepelin, by studying the entire life history of
his patients, was able to show that certain disease pictures when
studied in cross section may simulate one another very closely
clinically and at the same time be of the most diverse significance
prognostically. He further showed that certain acute psychotic
disturbances are merely the outward expressions of an underlying
progressive disorder, and though the acute manifestations may disappear
and leave no apparent trace behind them, the great majority of these
individuals will spend the rest of their lives in institutions for the
insane. By calling attention to certain symptom-complexes, which are
especially characteristic of certain mental disorders, he gave us the
means by which we are able at the present time to predict with a fair
degree of certainty what the future life of a given patient will be. We
can now tell without great fear of contradiction which of our patients
are going to spend the rest of their lives in institutions.
Now, criminality is generally conceded to be an expression of a diseased
personality and there is no reason why the same principles which served
to advance our knowledge of psychiatry should not be employed here.
In the foregoing study we aimed to carry out these principles, but we
believe that better results still could be obtained at the hands of a
trained psychiatrist right at the penitentiary. The reasons for this are
quite obvious. The relationship between prisoner and physician would
then be quite a different one, the data could be more readily verified
with the assistance of the machinery of the law, and the subjects would
be in a more accessible mood than when suffering from a mental disorder.
As a matter of fact the best work thus far done on the mentality and
disorders of mentality of prisoners was done by a prison physician, Dr.
Siefert, of Halle.
Thus we see that the question of the degenerative prison psychoses has
an important relation to the question of criminology in general.
This becomes at once apparent, if we accept the contention of many
authorities that the degenerative soil which makes the development of
these psychoses possible, is likewise responsible for the criminality of
these individuals; in other words,--if we agree that crime and psychosis
are here branches of the same tree. Manifestly any discussion of the
treatment of these psychoses must of necessity touch upon the vastly
broader problem of the treatment of the habitual criminal, the
recidivist, and therefore a slight digression from the subject at hand
will be unavoidable.
If we admit that it is the prison environment which serves to bring out
the prison psychosis, it is perfectly evident that the first therapeutic
indication is the removal of the prisoner from that environment as soon
as the disorder is recognized. This problem is at present dealt with in
several ways. There are certain penal institutions, especially in
Europe, which have within their walls a psychiatric department for the
reception of these cases. Others send their insane convicts to the
criminal department of some hospital for the insane. In this country
there are States in which still a third system is in vogue, namely, the
confinement of these cases in special hospitals for insane criminals.
Now the points to be kept in mind in the treatment of the insane
criminal are, briefly stated, these:--First, they should of course come
under the supervision of a trained psychiatrist. Second, the transfer
from prison to hospital must take place with as little delay as possible
and not be burdened with a lot of red-tape procedures. Third, the
hospitals for the housing of these patients must be fully equipped in
accordance with the modern ideas of hospital construction, and at the
same time afford ample security for the prevention of escapes. Fourth,
the interest of the inmates of the general hospital for the insane and
the feelings of their friends and relatives must be kept in mind, when
we begin to advocate the populating of our hospitals for the insane with
criminal characters.
The psychiatric annex in connection with the penal institution meets all
these requirements better than any arrangement for the care of the
insane criminal. An annex of say fifty beds, in connection with every
State Penitentiary would obviate entirely the delay in transferring a
patient from prison to hospital and _vice versa_. As soon as a prisoner
begins to show signs of mental disorder, and a prison physician trained
in psychiatry will be able to recognize these early signs, or as soon as
there is the least suspicion of mental disorder, the patient could be
transferred without delay to the psychiatric department. Here they
should be kept under observation for at least six months. This will be
sufficiently long in most instances to enable the physician to determine
whether he is dealing with a progressive deteriorating psychosis or with
one of those transitory prison psychoses. In the cases of the former,
_i.e._, if it is definitely established that the patient is a dementing
praecox or a paretic, the fact that he happens likewise to be a criminal
is really of little or no importance. A demented individual is never
dangerous enough to require confinement in an especially secure
hospital, though he is a prisoner, and unless he is criminally insane,
_i.e._, unless he manifests dangerous or criminal tendencies as a result
of his mental disorder, really forms no special administrative problem.
He could be kept either in the prison annex until the expiration of his
sentence, if there be room for him, or could be transferred to the
nearest hospital for the insane and treated the same as any other insane
patient.
It is the second group, however, _i.e._, those patients suffering from
the transitory prison psychoses, which especially justify the
establishment of psychiatric annexes in connection with prisons. We have
seen how detrimental to prison discipline these individuals are, even
when in a condition which might be considered normal to them, and we can
easily surmise what it must mean to care for them in prison during one
of their mental upsets. It is therefore of the utmost importance, both
for the prison administration and for the individual, that these
patients should be transferred to a properly appointed hospital in as
short a time as possible, and this can be done most readily when the
hospital and prison are within the same walls, and more or less under
the same management. On the other hand, we owe it to the prisoner to
bring him under proper care as soon as possible. The practice of sending
these individuals to criminal departments of general hospitals for the
insane has many objections. In the first place, no matter how modern the
equipment of such departments, most of them cannot afford the proper
kind of treatment to these individuals. The idea that the removal from
prison to a criminal department of an insane hospital will have a
beneficial effect upon the prisoner because of the more lenient
environment into which he is taken is entirely delusional in the case of
the degenerated habitual criminal. These individuals, if the public
safety is to be kept in mind, can receive but very limited privileges in
a hospital for the insane. The modern hospital is not constructed with
the idea of caring for dangerous criminals, and in many instances the
habitual criminal, who because of his dangerous tendencies and ever
readiness to escape, has to be constantly kept under lock and key, would
be much better off if he were treated within the enclosure of the
prison. There the construction of the place permits of a wider latitude
of outdoor exercise. An annex located within the enclosure of a prison
could well afford to allow its patients the freedom of the enclosure,
while this can manifestly not be done in a general hospital for the
insane. Then again, there is the unavoidable delay attendant upon the
commitment of a prisoner to an insane hospital. As I have already stated
elsewhere, it is not a rare occurrence to receive patients into the
hospital who have entirely recovered from their mental disorder before
leaving the prison. Furthermore, the expense and danger always
connected with the transfer of insane criminals from prison to hospital
and back again, if the hospital is any distance from the prison, must be
kept in mind.
A word to those who, from a false altruistic standpoint, insist that the
insane criminal requires no different treatment from that which the
ordinary insane patient does. This is very true in the case of prisoners
who develop mental disorders which have no relation to crime or
imprisonment. These do not require special measures of treatment. It is
likewise true of the psychoses of the accidental criminal, but it is
entirely different with the criminal who suffers from a degenerative
prison psychosis. Here we are not dealing with individuals who tend to
dement, who have little or no conception of whether they are in a prison
or in a hospital. In short, we are not dealing here with paretics or
senile dements, who, although being at the same time prisoners, remain
subject to the same unavoidable lot of the paretic or the senile dement.
The habitual criminal who suffers from a degenerative psychosis, unless
he is in a stupor, is constantly on the alert for a chance to escape. No
matter how delusional or hallucinated he may be, he always manages to
keep in mind that the thing which he most desires is to be free from the
hands of his captors, and anyone who has had to deal with this class
will bear me out in this. The shrewdness with which they carry out their
escapes is amazing, and some of the more depraved ones do not hesitate
to commit serious assaults in order to gain their freedom. Here,
measures other than those used with the ordinary insane patient are
required.
Now as to special hospitals for insane criminals which certain States
have. Of course the same objections, namely, as to the delay in getting
the patient under treatment and the danger of transfer, etc., hold true
also here; but these hospitals, it seems to me, have the additional
disadvantage that they necessitate the segregation of all insane
criminals, irrespective of whether they suffer from a recoverable
psychosis or from a dementing process. In other words, here we have an
admixture of cases who unfortunately fell into the hands of the law
because of some mental disorder and who certainly should be confined as
any other patient in an ordinary hospital for the insane, and patients
in whom the crime and mental disorder are expressions of the same
underlying degenerative defect, and who in a great majority of instances
suffer from recoverable transitory mental disorders.
To insist upon keeping a paretic all his lifetime in such an institution
is highly irrational, to say the least. The most rational, and the only
scientific way, of dealing with the insane criminal is to bring about a
state when the psychiatric hospital will be made accessible to him just
as easily as the surgical and medical wards are, and this can only be
accomplished by having psychiatric annexes in connection with prisons.
The only serious objection which can be raised against this plan is that
in time the annex will be made up exclusively of a very dangerous and
troublesome population, but this objection likewise applies to the
special hospital for the insane criminal. Certainly it is far safer to
have this class of cases within the prison enclosure than to allow their
accumulation in a general hospital for the insane.
Lastly, the psychiatric annex in the penitentiary would form the proper
nucleus for the scientific study of the criminal, whence that much
needed information concerning this type of man could emanate and be
utilized for the rational treatment of the problem of crime.
We have thus far discussed the treatment of prison psychoses in these
individuals while undergoing sentence, but what of them after the
expiration of their sentences? We are now approaching the problem of
recidivism.
Certain it is that society has thus far failed to deal effectually with
this problem, and one need not search very deeply for the cause of this.
Society has been relying principally upon its punitive methods in
dealing with the habitual criminal, and so long as a given offense was
punished according to a given statute it felt that it had done its duty.
The factor of the personality of the criminal was entirely neglected. In
time we have come to realize that our punitive methods not only do not
tend to do away with recidivism, but enhance it. It is an undeniable
fact that each additional imprisonment only serves to deprave the
habitual criminal more deeply, and to release him after the expiration
of an arbitrary sentence is to let loose another parasite to prey upon
society. Of late years, however, there has been a tendency toward
individualization in criminology. "It is the criminal and not the crime
that we must deal with," is the modern slogan, and starting from this
point of view we have already found out some very interesting facts. We
find in looking over the life histories of our habitual criminals that
they had shown antisocial and abnormal traits from their earliest youth;
that in their early manhood they populated the reformatories and that
their recidivism is due to some underlying anomaly which always
differentiates them from normal men.
In this chapter we have seen how this underlying anomaly served under
certain stressful situations to give rise to mental disorder, and have
concluded that crime and psychosis must be, in these individuals,
branches of the same tree. If this is true the question arises whether
the habitual criminal does not rather belong in a hospital than in a
prison. It is a little premature to decide this at the present day, but
it is unquestionably certain that it is the psychiatrist who will in
time furnish us the most valuable data concerning the "criminal
character." It is he who will eventually bring to light unshakable proof
that in the habitual criminal we must see an anomalous human being, who
stands in the same relation to normal man as disease does to health, and
then, the problem of recidivism as well as that of the psychoses of
criminals will be easier of solution.
REFERENCES
[1] WILMANNS: "Ueber Gefaengnispsychosen." Halle a. S., 1908.
[2] BONHOEFFER: "Klinische Beitraege zur Lehre von den
Degenerationspsychosen." Halle a. S., 1907.
[3] BIRNBAUM: "Zur Frage der psychogenen Krankheitsformen."
_Zeitschr. f. d. ges. Neurolog. u. Psych._ 1910.
[4] SIEFERT: "Ueber die Geistesstoerungen der Strafhaft." Halle a.
S., 1907.
[5] STRANSKY: "Ueber die Dementia Praecox, Streifzuege durch Klinik und
Psychopathologie." Wiesbaden, 1909.