THE FORENSIC PHASE OF LITIGIOUS PARANOIA
Maudsley[1] has long ago said: "It would certainly be vastly convenient
and would save a world of trouble if it were possible to draw a hard and
fast line and to declare that all persons who were on one side of it
must be sane and all persons who were on the other side of it must be
insane. But a very little consideration will show how vain it is to
attempt to make such a division. That nature makes no leaps, but passes
from one complexion to its opposite by a gradation so gentle that one
shades imperceptibly into another and no one can fix positively the
point of transition, is a sufficiently trite observation. Nowhere is
this more true than in respect of sanity and insanity; it is
unavoidable, therefore, that doubts, disputes and perplexities should
arise in dealing with particular cases."
No small amount of the disrepute into which expert medical testimony has
fallen is due precisely to a failure on the part of the legal profession
to appreciate these truisms. To the legal mind the transition from
mental well-being to mental disease is exemplified by that wholly
artificial, and to the psychiatrist's mind, subsidiary question of legal
certification. The law takes no cognizance of the conditions
necessitating this change; it only concerns itself with the delimiting
frontier, viz.:--certification. Legally, the insane has become such
through the filling out and signing of certain papers and through having
submitted himself to a certain prescribed legal procedure. The
physician, on the other hand, because of his peculiar relationship to
the patient, and as a result of his particular training, looks upon this
legal procedure as a necessary evil and merely as typifying the
conventional mode by which society settles its accounts with its
diseased members. Our legal brethren fail to appreciate, furthermore,
the fact that an individual may be very seriously ill mentally and
urgently require hospital treatment, without, however, showing those
gross disorders of conduct which go to make up the legal evidence and
diagnosis of insanity. Neither do they seem to recognize the possibility
of a seriously unbalanced individual making quite a normal impression,
at any rate before a jury of laymen at the time of his appearance in
Court. Nowhere in psychiatry is this so apt to be the case as in that
form of mental disease known as paranoia, where we are dealing with a
diseased personality which in many respects still approaches and
resembles normal man.
The paranoiac, while he may harbor the most intricate and well-organized
system of delusions, still remains approachable to us, and
intellectually may be not only on a par with the average normal
individual, but not infrequently gives the impression of being his
superior. Nevertheless, this usually well-endowed human being at a
certain point in his career goes off at a tangent and spends the rest of
his life in the pursuit of a phantom. The paranoiac, starting out with
vague, ill-defined ideas, succeeds in elaborating, step by step, a
well-organized system of thought, of ideas which finally assume an all
importance in the conduct of his life and remain unshakable.
Kraepelin[2] defines this condition as a mental disorder which is
essentially characterized by a gradual and systematic evolution of a
well-organized and intricate system of persecutory and grandiose
delusions. It is chronic and incurable in its course and does not lead
to any appreciable deterioration in the intellectual sphere. The
litigious form of this disorder is particularly characterized by a
persistent and unyielding tendency toward litigious pursuits. It is for
this reason that this form of paranoia is of particular interest
forensically. The law is the tool with which these individuals work, and
the Courts their battle-grounds. The least provocation suffices to start
the stone rolling, launching the unfortunate upon a career of endless
litigation. As a rule the disorder originates in connection with some
adverse decision or order of the authorities, which the patient
considers an unjust one. Whether injustice has actually been suffered by
the patient matters not and remains absolutely of no consequence as far
as the course of the disease is concerned. The paranoiac litigant is
unable to see the law as others see it, and in this respect he does not
differ greatly from primitive man, whose conception of legality is that
of a collection of concessions for himself and prohibitions for others.
To be sure, a tendency to excessive litigation is occasionally met with
in what appear to be normal people. Such pursuits, however, become
pathological when they are based upon a delusional interpretation of
actual occurrences or upon actual delusions, and are not amenable to
reason.
According to Tanzi[3] the theme underlying the delusional system of
litigious paranoiacs is avarice, and the whole may be looked upon as the
slow and permanent triumph of a preconception. "The paranoiacal
preconception gradually conquers all evidence to the contrary, and in
spite of reality, public opinion and common sense, it becomes organized
into a cooerdinated system of errors which become the tyrants of the
intellectual personality and remove it by degrees outside the bounds of
normality." The litigant constantly busies himself with his grievances,
loses all interest in everything else, and begins to fight for his
rights. He stops at no means and is the bane of judges and court
officials. Naturally, he has to be refused all aid, either because he is
unjust or because the courts find no remedy for his troubles. He refuses
to settle actual grievances, carries the case from one court to another
and finally develops an insatiable desire to fight to the bitter end.
The statutes appear to him inadequate and even the fundamental
principles of law fail him. He cannot abide by the ultimate decision
after all the usual means of justice have been exhausted. In his
attempts to gain justice he writes to magistrates, legislators and
various other people in prominence. It is only after years of persistent
misfortune both to himself and the objects of his delusions, which only
serve to harden him against his fortunate opponents, his incapable
lawyers, the corrupt judges and his ignorant and craven-hearted
relatives, that this master of procedure is betrayed into the expression
of threats or the commitment of some other offense which conveys him
summarily from the civil to the criminal courts, and the unrepentant
pursuer becomes the defendant, unless, indeed, the insane asylum has
become his refuge. (Tanzi.)
This is precisely what happened with the patients whose histories are
here recorded. With all this the paranoiac remains plausible, converses
rationally and coherently, shows himself to be exceedingly well-informed
on current events, amazes his listeners with his really wonderful memory
and his ability to quote _ad infinitum_ from law books and statutes.
Absence of hallucinations is the rule. Memory and the capacity to
acquire new knowledge remain intact, and reasoning and judgment on
matters of everyday life which do not touch his more or less
circumscribed delusional field may remain quite normal. In short, he
shows none of those tangible signs and symptoms upon which we must so
frequently rely in our efforts to convince a jury of laymen of the
existence of mental disorder. It is only when we take into consideration
the entire life history of a paranoiac, which unfortunately is
frequently ruled out as hearsay evidence, that the real state of affairs
becomes manifest. We then see that where it concerns his delusional
field the paranoiac's judgment is formed, not as a result of
observation, or logic and reasoning, but as a result of an emotion, a
mere feeling that this or that proposition is true. In every adverse
decision of the court he sees a deep-laid conspiracy to deprive him of
his rights. His lawyers are incompetent and in collusion with his
persecutors; the judge is corrupt or ignorant of the law, and the
legislators negligent in their duties in not writing into the statutes
laws which would take care of his grievance. He constantly harps upon
what he calls "the principle of the thing", losing, gradually, all
concern in the real issues involved.
Indeed, in watching the amount of attention a paranoiac bestows upon his
grievances, the zest with which he takes up every newly discovered flaw
in the law, and the dexterity with which he weaves it into the maze of
his delusional system, the idea forces itself upon one's mind that what
the paranoiac least desires is a settlement of his grievances. One can
readily imagine the void in the unfortunate's life were he to be
deprived of this all-engrossing, and to him really life-giving, _casus
belli_. Thus, not infrequently, when one grievance is actually settled,
another soon appears and assumes the center of the stage. The means
these individuals use in their efforts to convince the authorities of
the righteousness of their cause or of the genuineness of the
persecutions to which they are subjected, are really amazing in their
ingenuity. They are supported to a considerable extent by retrospective
falsifications of memory, and when occasion arises, by a conscious
distortion of facts, and prevarication, a point very justly emphasized
by Bischoff.[4]
This author relates the case of a paranoiac woman who was in litigation
with her father over some trifling inheritance left by her mother, and
who accused her father of a murder, and insinuated that she had heard
her grandfather call him a fratricide.
The reputation and character of the objects of their delusions are
unsparingly attacked by the paranoiac litigant, and this not
infrequently results in bringing matters to a head, where as defendant
in a criminal suit for libel the paranoiac is recognized in his true
light and sent to a hospital for the insane. Before, however, this final
scene in the litigious career is enacted, especially where the
persecuted has turned persecutor, the objects of his delusions have not
infrequently suffered an untold amount of anguish and financial ruin,
through having been obliged to play the part of defendants in civil
suits based on nothing else but the distorted fancy of a diseased mind.
While one may readily detect the part played by avarice in the pursuits
and activities of these individuals, it requires close contact with
them, especially in the capacity of one who stands between them and
freedom, in order to fully appreciate the degree of malevolence which
they frequently exhibit. Indeed, the study of litigious paranoia, more
than anything else, illustrates how much method there may really be in
madness. Were an alleged lunatic standing as a defendant in a criminal
suit to use one-tenth of the amount of ingenuity and conscious direction
of his symptoms that the average paranoiac uses, he would furnish the
champions of the idea of malingering of mental disease with enough
material to convict a dozen lunatics.
The chief aim of this paper is to illustrate by means of two interesting
case histories the forensic importance of this form of mental disorder.
It is not intended, however, to enter here into an academic discussion
of the problem of paranoia. The term "Paranoia" is even pre-Hippocratic,
and any attempt to indicate, even in the briefest manner, the changes
which this concept has undergone throughout the ages would require
considerably more space than we have at our disposal. I shall,
therefore, merely mention that in reviewing the history of paranoia one
is unmistakably struck by the fact that those view points and ideas
concerning this subject which have indelibly impressed themselves upon
it occupy themselves with a study of the personality of the paranoiac
rather than with the disease picture as such. Some of the investigators
have gone so far as to maintain that paranoia is not a disease at all
in the sense that typhoid fever is a disease or pneumonia is a disease,
but that the paranoiac picture is rather the expression of an anomalous
individuality and, as one author puts it, it is the evolution of a
crooked stick. Sander[5] recognized this when he so admirably stated
that the abnormal condition develops and unfolds itself in the same way
that the normal mind unfolds itself in the normal individual.
The cases herein reported have been under my observation now for several
years at the Government Hospital for the Insane, and I am indebted for
permission to report them to Dr. William A. White, Superintendent of the
Hospital.
CASE I is a white man, aged 64 on his first admission to the
Government Hospital for the Insane, July 9, 1907. This commitment was
the direct outcome of a trial for perjury which took place in May,
1906, in the Supreme Court of the District of Columbia, at which the
patient was found guilty. While awaiting sentence he was adjudged
insane and sent to this Hospital. The evidence was gathered from the
Reports of the Maryland Court of Appeals, dating as far back as 1874,
and forms only an incomplete account of the patient's legal
activities, inasmuch as many of his law transactions never reached the
higher courts and consequently are not reported. In setting aside
1,296 magistrate's judgments obtained by the patient and amounting in
the aggregate to $127,836 debt and $2,348 costs, the Court states,
among other things, as follows:--
"The gross iniquity of this whole transaction, manifest enough upon
its face, is abundantly so by proof. The inference is irresistible
that the magistrate who issued these judgments merely wrote them out
on his docket without summoning witnesses and without the semblance
even of an _ex parte_ trial."
It was further brought out at the perjury trial in 1906 that in 1877
the patient had obtained 619 judgments against the A. E. Company,
aggregating approximately $50,000. These were likewise set aside by
the higher Court. We thus see that as far back as 1874 this king of
litigants had already had set aside by the higher Courts as many as
some 1,900 distinct and separate judgments. How many more of those
based on the same flimsy tissue of his distorted imagination he
actually realized on is not known. As far as can be ascertained, the
issue of insanity was never raised, at any rate by the Court, prior to
the perjury trial, and it was only when this master litigant, after
having been active as a complainant for a great number of years, at
last betrayed himself into committing a criminal offense that the
issue of insanity was brought up.
A prominent Maryland Judge, who had known X---- for over forty years,
had the following to say concerning him:--"I have known X---- for
forty years, and he is a general nuisance and menace; he is crazy on
getting money, and for years has been manufacturing bogus judgments
against citizens of this and Montgomery Counties and the
A. E. Company. At one time he held judgments against that Company for
a million dollars for an imaginary wrong, all of which were eventually
gotten rid of on the ground that they were fraudulent. He also, in
some fraudulent way obtained judgments against our County
Commissioners, without their knowledge, for $1,500, which were
impounded by Judge M---- of the United States Court at B----, where as
a then non-resident he brought suit to recover on them. He then went
down to Dickinson County, a remote section of Southwestern Virginia,
and obtained other judgments for some four or five million dollars
against the County and various citizens, which were obtained by
perjury and forgery. They were eventually set aside. His brother died
in 1907, and I became one of the sureties on the executor's bond; last
year a judgment turned up here against the executor and his sureties
for $17,000, which purported to have been given by the Circuit Court
for said D---- County. It was a forgery all the way through; even the
Seal of the Court to the certificate was a forgery. I wrote the Judge
of the Court and he answered very promptly, stating that no such suit
had ever been entered and that the judgment was a myth. We succeeded
in impounding this judgment. No one up here feels safe when X---- is
at large. We have suffered a great deal of trouble and expense in
trying to protect ourselves against him, and everybody regards him as
being not only insane but also a very dangerous man."
On admission to the Government Hospital for the Insane, July 9, 1907,
he was found to be a fairly well-preserved man for his age, entered
freely into conversation, comprehending readily what was said to him
and exhibiting no difficulty in elaborating his ideas. He talked in a
slow, deliberate and rather mysterious manner and a low tone of voice.
The family history as given by him was negative. He himself had the
usual diseases of childhood, but, aside from chronic indigestion, had
had no severe illness. He gave his occupation as that of physician. In
1862 he enlisted in the Union Army as a nurse and was discharged six
months later; claims that in 1865 he graduated in medicine from the
University of Maryland, which profession he practiced at W---- until
1881. He then moved to Ohio, because, he says, he could endure no
longer the persecution of a good many enemies which he had made on
account of his service in the Union Army. In Ohio, he states, he
engaged in the manufacture of proprietary medicines and claims to have
sold out his business sometime later for $50,000.
Some idea of the patient's daily conduct may be had from the
statements of his landlady, with whom he lived for a considerable
time.
It seems that he occupied a room on the top floor, which he would
allow no one to enter. If anyone rapped on the door he would open it
very slightly and cautiously, conducting conversation through a crack
in the door. He led the life of a hermit, living in absolute
seclusion, cooking his own meals in his room. After he was removed to
the Hospital this room was entered and newspapers were found piled as
high as the ceiling; many of the articles in them were underscored,
and numerous clippings were pasted on doors and windows as well as on
walls; everything was covered with dirt and dust, and the cooking
utensils were strewn all over the room. This lady said that during his
stay there he was always very suspicious, kept the blinds drawn, and
seemed to be constantly afraid that something was going to happen.
Examination of the patient soon after admission revealed a
well-organized and very extensive delusional system, which, according
to his story, apparently had its inception during the Civil War. It
seems that he had caused the apprehension and execution of a
Confederate spy, and ever since then, he states, the relatives and
friends of this man have been persecuting him. In 1889 he was granted
a pension of $25 per month, but he did not think that this was a fair
deal inasmuch as he was not a nurse, but a physician, and should
receive at least a hundred dollars per month. He states that he came
originally to Washington to have this matter straightened out, but on
account of his enemies was unsuccessful. His worst persecutions he
believed to have been instigated by the A. E. Company because he had
judgment against this Company for about $50,000. He stated that this
was obtained in a damage suit which he brought against this Company
because they wanted to charge him expressage of something like 40c on
a prepaid package. Following this damage suit, the Express Company's
agents, especially members of the R. family, have been spying on him
and persecuting him; he finally sued a member of this R. family and
obtained judgment against him in the Circuit Court of Virginia for
$9,000. When asked to explain how he figures out these exact amounts
of damage, he is ready with a thousand plausible reasons why the
amounts were as he gives them. He was finally charged with perjury,
found guilty, and while awaiting sentence was adjudged by a jury to be
of unsound mind and sent to the Government Hospital for the Insane.
He believes that members of this R. family were behind this because
they were afraid that the patient would collect on his judgments,
which by this time, amounted to something like $20,000, and which, as
he put it, "were good, valid and subsisting, not reversed or otherwise
vacated."
During his sojourn in the Government Hospital for the Insane, he was
always very suspicious and seclusive, keeping to his room practically
all the time and aloof from the other patients in the ward. He adhered
very tenaciously to his delusional system and believed himself fully
justified in all his litigious pursuits. With all this he was clear
and coherent in conversation, his memory was quite well-preserved, and
he had no difficulty in keeping himself fully informed on current
events. Aside from the very evident caution and very profound
suspicious attitude which he manifested during a conversation, he made
no abnormal impression.
In October, 1908, he was paroled by a Justice of the District of
Columbia Supreme Court to his brother's care in Ohio; and patient's
reasons for this parole are interesting: He states that he was told by
the District Attorney that he would be paroled if he were to go to
Ohio and vote for President Taft. This he says he did, believing he
had carried out the terms of his parole, promptly returned to
Washington and resumed his former activities. The first thing he did
upon his return was to have the following two bills introduced in
Congress, both of which are wholly based on his delusional ideas:--
"H. R. Bill xxxx, January 11, 1910. Mr. A. introduced the following
bill, which was referred to the Committee on Military Affairs and
returned to be printed:--A bill to correct the military record of
X----. Be it enacted in the Senate and House of Representatives of the
United States of America, in Congress Assembled, that the Secretary of
War be and is hereby authorized and directed to correct and amend the
military record of X----, late assistant surgeon instead of nurse, so
as to read: X----, Assistant Surgeon of the United States Army, on the
12th day of April, 1863, and to place the name of X---- upon the
retired list of the United States Army as Assistant Surgeon."
The second bill was as follows:--
"Senate Bill xxx. Referred to the Committee on Claims. A bill for the
relief of X----. Be it enacted by the Senate and House of
Representatives of the United States of America, in Congress
Assembled, that the Secretary of the Treasury be and he is hereby
authorized to pay out of any money in the Treasury, not otherwise
appropriated, to X----, formerly a resident of W., in the State of
Maryland, the sum of $45,600, being the amount of the loss sustained
by said X---- in property and business while he was performing
important service for the Government in the year 1863, and in
recognition of valuable service rendered the United States, and
compensation for loss resulting from his causing the arrest of a
Confederate Spy, at the opening of the Gettysburg campaign, thereby
defeating the Confederate plan to capture the two thousand or more
government wagons loaded with the munitions of war of the Union Army,
which sum shall be in full of all claims and demands upon the part of
said X---- against the Government of the United States by reason of
the premises."
The patient was soon apprehended and returned to the Government
Hospital for the Insane, where he is at present.
In an extremely interesting brief of his case, prepared by the patient
himself, which, unfortunately, is too lengthy to be given in its
entirety here, he states, among other things:--
"I was indicted on the 2nd of April, 1906, by the grand jury of said
court, for perjury; the grand jury was about to adjourn, as they had
no evidence upon which to indict me, but they were called back to do
so in order to please the A. E. Company. The grand jury was authorized
to indict me in order to please the A. E. Company, as I was later told
by several members of that jury. I have also been told by numerous
detectives that they were hired by the A. E. Company to watch me." He
continues in his brief:--"I was kept in jail until the eve of the 13th
of February, 1905, when the jail doors were suddenly thrown open and I
was told to go home, the same as the circumstances related in the
Bible concerning St. Paul and Silas, who were in prison and during the
night their chains fell off, the prison doors opened and they were set
free by the hand of God. I believe the same thing happened to me; I
was released by the hand of God."
He further states:--"There are more than 17,000 newspapers in the
United States, and these people had it printed in 10,000 of them that
I had committed perjury. I sued them for slander, and a more just and
upright case or grievance for bringing suit could never be found."
Attention might be called here to the grandiose phase of his disorder.
His was no common slander; it was published in 10,000 newspapers.
Neither was his release from prison an ordinary everyday occurrence,
but resembled the Biblical episode of St. Paul's release from prison.
Later on, when through advancing years his intellect is becoming more
and more enfeebled, he expresses his grandiose ideas in a more direct
and naive manner. He tells the physician that he knows the law better
than any living authority; that none of the so-called judges around
town can compare with him; that he has made a brief of a case which
could not be duplicated by anyone. He is likewise the greatest
physician, and he will prove this when he gets to court. At this
writing he is beginning to show evidence of senile deterioration and
is no longer the keen manipulator of the law of years ago. He
endeavors now to gain his ends by more direct and extremely puerile
and childish methods. To illustrate:--His physician had left the
institution about a year ago, and soon afterwards X---- produced an
affidavit purporting to have been made by this physician in which he
set forth that X---- was sound mentally; that this physician came to
this conclusion after a thorough examination of X----, etc., etc. Upon
the physician's return to the Hospital X---- was asked concerning this
by him, but he stolidly maintained that it was genuine and given him
by the questioner. This famous litigant has reached a stage where
things simply are as he wants them to be. Whether this poor derelict
will be permitted by his deluded or unscrupulous attorneys to end his
days in peace at the Hospital, time alone will tell. Thus far his
lunacy case has been carried by them to the Court of Appeals.
CASE II.--Y. was found guilty of libel in the Criminal Court of the
District of Columbia, and while awaiting sentence was adjudged insane
by a jury and admitted to the Government Hospital for the Insane,
June 22, 1911, at the age of 56. Y. is an attorney by profession,
comes from a prominent family in Ohio, and has received an excellent
education. According to information obtained from his father and
sister, it appears that one sister and a nephew are insane; that the
patient himself has been considered insane by members of his immediate
family since 1889, when, as the result of a court-martial for
disobedience, he was discharged from the Navy, where he then held the
grade of ensign. Immediately following this discharge he took up the
study of law and began to specialize in maritime affairs, handling
almost exclusively sailors' grievances against the Navy Department. He
spent a great deal of time working up these cases, occasionally
writing contributions to the Maritime Register, for which publication
he was a regular correspondent for several years. In these papers he
would constantly harp on the irregularities and illegalities of many
of the government affairs. At home he always acted in a peculiar
manner, never had much to say to anyone, was unreasonable,
fault-finding and complaining; he always wanted things his own way.
Several years ago he came to live with his sister, accompanied by his
wife and child. Although he paid nothing for board and lodging for the
three, he complained about the food and had something to say in
criticism for every little inconvenience. He would frequently leave
town without saying a word to any member of his family, and would
reappear just as suddenly. He kept to his room almost constantly,
leaving same only for his meals. On one occasion he wrote his wife,
who at the time was staying with her child at his sister's house, that
she should watch this sister, as he feared she might try to poison the
child. Sometime in 1910, he came to his home town, had an interview
with the Judge of the Probate Court, and left town without visiting
any of his relatives, although they lived only four squares distant.
At that time this Judge told the patient's father that he thought the
patient was mentally unbalanced. He was always considered by his
relatives as being of a morose disposition, vindictive and selfish. On
a later visit to his parental home he acted very strangely about the
house, disarranged things, kept the rooms in disorder, and was busy
writing constantly. At this time he left home suddenly without taking
leave of anyone. A few years ago, while home on a visit, he declared
that his father was incompetent to manage his own affairs, instituted
legal proceedings to have himself appointed committee for his father,
petitioning the court on the ground of his father's insanity. In this,
of course, he was defeated.
The patient himself states that he graduated from Annapolis in 1878,
between which year and 1883 he traveled in Europe and South
America as midshipman. In 1883 he entered the Cincinnati Law School,
where he remained one year. After this he states he acted in the
capacity of Judge Advocate General for a short time while on shore
duty. He then went to sea again and finally resigned from the Navy in
1887, with the grade of ensign. (As has already been indicated above,
the patient was dismissed from the Navy for disobedience and
disrespect.) He then entered the practice of law in Cincinnati, at
which he continued until his appointment to the Department of the
Interior on June 1, 1904, at a salary of $1,000 per annum. Here he
remained until 1908 in the capacity of clerk, when he resigned,
receiving at that time the same salary. He says he was moderately
successful financially as a lawyer, and did a good deal of literary
work. He is especially proud of a case which he conducted in the Court
of Appeals, where he obtained a decision setting aside a Naval
court-martial. He says that this is the only decision of its kind ever
rendered, and on that account he is very proud of this. According to
his own story, he was always moderate in his habits, and prior to his
marriage in November, 1902, he had never come in conflict with anyone.
The latter part of this statement is contradicted by his relatives,
who state that for more than twenty years past, the patient has
exhibited an uncontrollable desire to sue people for all sorts of
imaginary grievances, and that on this account he frequently came into
serious conflicts. The patient is inclined to put all the blame for
his difficulties to his wife, whom he describes with a great deal of
rancor as the descendant of an insane and illegitimate grandfather and
illy-favored mother. He thinks that his wife was slightly unbalanced,
accuses her of being responsible for the death of their first child,
and of various other misconduct. However, everything went tolerably
well until April, 1906, when their second child was born. The doctor
who attended Mrs. Y. during her confinement, a very prominent local
physician, testified in open court at that time, that from his
observation of the patient's acts he believed him to be insane. This,
the patient said, precipitated a lot of trouble between him and his
wife. He does not enter into details concerning the difficulties he
had with the physician, but the details are extremely illuminating. It
appears that the patient refused to pay this doctor's bill and was
sued for the debt. At the time of the trial he gave as his defense the
following two reasons why he should not pay this bill:--The first one
was that inasmuch as this doctor lived in a part of the city which
would necessitate the crossing of a railroad grade in order to reach
the patient's house, and that on this account there was a possibility
of his being detained at the crossing during an emergency call, he had
no right to take the case in the first place, and therefore he was not
entitled to payment. His second reason was that inasmuch as this
doctor wore a beard, he carried more germs into the house than would
otherwise have had access to it; therefore he should forfeit his fee.
In 1907 his wife obtained a divorce on the grounds of cruelty and
non-support, and was given the custody of the child; this had the
effect of launching the patient upon a new series of litigation. His
first retaliating measure was the abduction of the child, which
brought about his indictment by a grand jury and subsequent arrest.
The reason he gave for taking the child out of the District was that
his wife lived in a house over an old abandoned cellar, and that it
was therefore an unhealthy place for the child. Upon regaining his
freedom he began to investigate the ground upon which the grand jury
indicted him, and soon, he states, he discovered that the District
Attorney's office committed a gigantic fraud by having maliciously
misrepresented the case to the grand jury; this body, he says, was led
to believe that the Ohio decree granting his wife the guardianship of
the child held good in the District, whereas the law of the District
specifically states that no extra-territorial decree should be
recognized within the District. He further discovered that Mr. J., his
wife's attorney, knowingly and maliciously became a party to this
fraud, and he immediately proceeded to file charges of mal-practice
against this attorney before the Grievance Committee of the District
Bar Association. The result of this was that the patient was charged
with libel in the Criminal Court. To his great surprise, he says, the
Court recognized this charge and found him guilty of same. While
awaiting sentence he was adjudged insane by a jury and committed to
the Government Hospital for the Insane. He believes this commitment is
the result of a deep-laid conspiracy on the part of the District
Attorney's office and some of the District Judges. These officials, he
believes, were afraid of him because at a hearing before a Senate
Committee he started to expose their fraudulent conduct. The judges
were prejudiced against him throughout, and it might be interesting to
mention here that among the multitudinous bills which he had proposed
for enactment into law since in the Government Hospital for the
Insane, there is one which is intended to abolish entirely the Courts
of the District of Columbia, so that unfortunates like him might get a
chance before unprejudiced judges. This deep conspiracy against him,
he is convinced, dates as far back as 1906, when the Ohio Courts
appointed his wife guardian of his child.
No great difficulty need be experienced in forming an opinion of this
man's mental status after having followed his history thus far, but
when we further read that, during his sojourn in the Government
Hospital for the Insane, he has evinced the most persistent tendency
to weave into his delusional system every important occurrence of
local or even national interest, that he sees a clear relationship
between his case and the recent change of administration, and is fully
convinced that many important officials held over from the last
administration owe considerable gratitude to him; when he is seen in
his self-assumed most important role of the man of destiny, flooding
Congress, the Courts and many high officials with petitions, charges,
writs, and proposed investigations; when one sees the criminal code as
transformed by him; then one begins to get a proper perspective of the
grandiose phase of this man's mental disorder. It is impossible, of
course, with the limited space at our disposal, to even give the
briefest outline of his activities, but it might be stated that only
within the past several months he has succeeded in very ingeniously
getting his case before a considerable number of senators and
congressmen and many other prominent officials. Among the bills which
he proposes to have enacted into law, is one, as has been mentioned,
to abolish entirely the Courts of the District of Columbia. Of course,
courts which cannot administer justice, as he sees it, must be
abolished.
On his admission to the Government Hospital for the Insane, he really
welcomed the procedure, stating that at last he had the opportunity to
be under the supervision of a trained physician who would soon
discover that he was absolutely sane and would render a report to that
effect, thus vindicating him. Unfortunately for the physician, he did
not see his way clear to render such a report, and Y's amiability soon
changed into a very bitter antagonism towards the one who had
immediate charge of him, showing a great deal of rancor in his attacks
upon him, in spite of the fact that he has been accorded all sorts of
privileges. He has, of course, by this time consigned many hospital
officials to life imprisonment, and the amount of damages which he
expects to collect from them and the Government runs into fabulous
sums. He soon began to solicit the grievances of his fellow patients,
establishing, so to speak, a law office in miniature upon the ward;
and whereas formerly these patients in the criminal department merely
aired their grievances as they saw them, they now accompany them with
quotations from the statutes concerning these points furnished by this
legal missionary. Soon, however, even the insane patients on his ward
began to distrust him, and at the present time there is hardly an
attendant or patient in the building who cares to associate with Y. He
missed no opportunity of playing upon the credulity of the younger and
less sophisticated attendants in the criminal building, at first
begging and urging them to carry his petitions to their destination in
a surreptitious manner, and finding this of no avail threatening them
with fines and imprisonment as accomplices in this gigantic crime of
keeping him confined in a hospital. When not out walking he keeps
himself constantly busy making out documents, briefs, petitions,
bills, etc. He is very seclusive, keeping himself aloof from the other
patients, as he considers himself very much their superior.
Now this master litigant, this profoundly diseased man, succeeds in
making quite a normal impression in a casual interview, and in his
writings he frequently succeeds in conveying the idea of being quite
normal. Each isolated fact looks plausible enough to the casual
observer. He talks quite rationally, shows a remarkably well-preserved
memory, has never exhibited hallucinations or those gross disorders of
conduct which to the lay mind form the _sine qua non_ of mental
disease. It is only after a close study of the entire life history, of
the many fine shades of deviation from the normal which this man
exhibits, that one discovers that his mind is very seriously affected
indeed, and that because of his plausibility he belongs to a rather
dangerous type of mentally diseased individuals.
The chief aim of this paper has already been indicated, and we shall
adhere to our original intention of rendering it as free from purely
didactic considerations as is consistent with clearness. For this reason
the case histories given above were considerably abbreviated and only
such an account rendered as would suffice to convince even a layman that
the two individuals in question are seriously affected mentally. Of this
there should not be the slightest doubt in anyone's mind, neither should
one encounter here any diagnostic difficulties. The only difficult
point, and a point which may become of considerable forensic importance,
is the exact estimation of the duration of the illness in each instance.
From the available data at hand it would seem that in the case of X----,
the disease had its inception in the episode during the late Civil War,
though the possibility of retrospective falsification must be kept in
mind; while Y seems to have been launched upon his litigious career by
his dismissal from the Navy. It is therefore but fair to assume that in
both instances the disease has existed for a great number of years.
Nevertheless, it was only when these individuals faced the bar as
defendants in criminal suits that the disease was recognized in either
case. One may readily see, therefore, how easily mental disease may
remain undetected, especially if one neglects to take an inventory of
the individual's past life. I have already alluded to the difficulty
frequently experienced in having evidence of this nature accepted in a
court of law, and here, it seems to me, is room for a good deal of
reform in procedure. Thus far society's side of this problem has been
chiefly emphasized; but what about these unfortunate derelicts, X----
and Y? Both of them are at present confined in the criminal department
of the Government Hospital for the Insane with criminal charges pending
against them. Assuming that our contentions with respect to their mental
status are correct, what possible justification is there to hold them
responsible before the law for their acts? Nevertheless, the same sort
of procedure is constantly taking place; individuals are being sent
daily to hospitals for the insane, presumably for the purpose of giving
them the best possible chance for recovery, the best modes of treatment,
while at the same time the law persists in carrying them as individuals
charged with crime, thus throwing many obstacles in the way of proper
care and treatment. With many of these individuals the mere fact that
there is still a criminal charge pending against them seems to act in a
deleterious manner upon their mentality, while in the great majority of
instances, owing to the fact that they must be carried as criminals,
unusual precautions have to be resorted to both in their confinement
and in the matter of various privileges, thereby vitiating in a great
measure all attempts at treatment.
These are some of the problems which present themselves from a study of
life histories such as are here reported, a better mutual understanding
concerning which between the lawyer and the physician would
unquestionably tend to a more enlightened administration of the law.
REFERENCES
[1] MAUDSLEY: "Responsibility in Mental Disease."
[2] KRAEPELIN, E.: "Psychiatrie." Achte Auflage. Leipzig, 1910. Bd. 1.
[3] TANZI: "Mental Disease."
[4] BISCHOFF: "Lehrbuch der Gerichtlichen Psychiatrie." 1912.
[5] SANDER: Quoted by White. "Outlines of Psychiatry." Fourth Edition.