{259}
One of the most interesting phases of epilepsy is the type of the disease in which, without any significant motor symptoms, psychical manifestations prevail very markedly. A special manifestation in this affection is the occurrence of a more or less complete assertion of what is called a secondary personality. Apparently the individual becomes so divided in the use of the mental faculties that there are two states of consciousness. In one of these the patient knows and remembers all the ordinary acts of life, the other carries the record of only such actions as are done in a peculiarly morbid psychic or epileptic condition. It is rather easy to understand that this strange state of affairs may readily give rise to even serious complications as regards the individual's relations to others, and may make the problem of responsibility for apparently criminal acts that have been performed very difficult of solution. Undoubtedly, however, this set of phenomena constitutes a form of mental alienation that must be reckoned with in many more cases than might be thought possible. The difficulties that may have to be encountered in the proper appreciation of the actions of such individuals is best illustrated by some cases.
At a recent meeting of the New York State Medical Association a case was reported that shows how extremely difficult it may be to judge of responsibility under these pathological circumstances. The patient, a young man of about twenty-two, was the son of parents themselves of marked nervous heredity, signs of which appeared in other members of his generation. While in attendance at a public academy he had been quite severely maltreated during the{260}course of an initiation into a secret society of the students—the more or less familiar processes known as hazing being employed. As a result of this he had suffered from an attack of unconsciousness that lasted for several hours. No other symptoms, however, or sequelae, appeared for nearly a year. Then, while boarding with his sister, he became morose and difficult to get along with. He quarrelled with his sister several times and generally their relations were rather strained. He came home one evening very late to supper, and because things were not to suit him on the table, he grew violently angry. He went upstairs to his room in this morose state and, procuring a revolver, after a short time came down and shot at his sister.
Fortunately he missed her. He at once left the house but was followed by his brother-in-law, and, after he began to run away, by others whose attention had been attracted by the shot. He left the country road and ran across the fields. He was found at the foot of a rather high stone wall in a state of unconsciousness. From this unconsciousness he did not recover until the next morning. In the meantime he had been brought home and put to bed. The next morning he claimed that he had absolutely no remembrance of anything that happened after he became angry at the table because of his supper. The family made no further difficulty about the matter, and, as nothing serious had resulted, the boy went home to live with his father on a farm and seemed to grow much more equable in temper.
One day, when very tired and out of sorts because things had not been going as he wanted them to, he was asked to clear a potato patch of potato bugs by spreading Paris green over it. Some hours later he was found in the field suffering from severe pains in the stomach and with evident signs of having swallowed some of the poison. A doctor was called, an emetic was given and he purged, and after a time he recovered from the symptoms of poisoning. He claimed that he had no recollection of what he had done, nor did he know how he came to take the poison. After this he begged the family to watch over him carefully and not to let him be alone at times when they recognised that he was somewhat{261}morose in temper. He was not melancholic in the sense that he wanted to commit suicide, but something seemed to come over him in spells, and while in a state of mind of which he had no recollection afterwards, he performed actions that seemed voluntary and yet were not.
He did not have very good health on the farm, and so he was advised to try the effect of life at sea. A position as assistant steward was obtained for him on a coastwise vessel. In this position he gained rapidly in weight and seemed to have excellent health. All tendencies to moroseness of disposition disappeared. After a time he was promoted to a stewardship and later became the purser of a rather important vessel. He has given excellent satisfaction and feels in every way that he is in a much more balanced condition than ever before.
He still insists that he remembers nothing of how the two almost fatal incidents in his life came about. All his family are convinced that it was not a responsible state of mind that led him to attempt either of the crimes. It seems not improbable that this is one of those fortunately rare cases in which an attack of psychic epilepsy sometimes obliterates for a moment the individuality of a patient. At times these attacks last much longer, and the change to a secondary personality may represent a rather long interval. A number of cases of what are called ambulatory epilepsy have been brought to the attention of the general public of late years because of certain interesting features of the cases that have been exploited in the daily press.
Patients suffering from this form of nervous disease may wander from their homes, and while performing automatically a number of actions, such as buying tickets, travelling on cars and railroad trains, or even arranging the details of their journey for a long distance, may yet be in a state of mind that is not their ordinary consciousness. Men may leave home under the circumstances and find themselves after months in a strange town where they have established themselves in some quite different occupation from that to which they were formerly accustomed, or for which their early training fitted them. There seems to be an absolute division between the{262}states of consciousness that rule the individual during the intervals of ordinary and extraordinary personality. There are, of course, many reasons for thinking that at times such a change of personality might be feigned; but many of the cases have been followed with too much care to allow this thought to serve as an explanation for all of them.
A case which serves to bring home very clearly the possibility of such a state of mind giving rise to serious complications is the following: The patient was a young man in attendance at the medical school of a university in a foreign city. He had been very careless in money matters, and had aroused family suspicion that even the money sent him for tuition was being used extravagantly. A friend of the family came to see him unexpectedly in order to assure himself how the boy was actually getting along. The boy's accounts were in a very disordered condition; he had not bought the books for which he pretended to want money; he had not paid his tuition. He realised that all this would come out as soon as the university authorities were consulted. Very naturally he was in an extremely perturbed state of mind.
While on the way to the university with this friend they passed a corner pharmacy, and the young man asked to be allowed to step in for a moment for a remedy for headache. The friend waited on the sidewalk for him, and when, after some minutes, the young man did not come out he went in to inquire for him, and found that after purchasing a headache powder the young man had gone out by a side door. For three days nothing was heard from him. Then a telegram announced that he was in a hospital in a distant city and that he had been picked up on the street unconscious. When he came to in the hospital he had no idea where he was, and, according to his own story, no recollection of how he got to the distant city.
It might be very easy to think, under such circumstances, that this was all pretence. A number of these cases of ambulatory epilepsy have been under the observation of distinguished neurologists, however, and there seems no good reason to doubt that some of them, at least, were entirely without any fictitious element. In any given case the{263}possibility of the occurrence of an attack of what is really the assumption of a secondary personality must be judged from the circumstances, from the previous history of the individual, from the family traits, and from certain stigmata as narrowing of the field of vision and the like, which go to show the existence of a highly neurotic constitution. In this case the family history showed marked neurotic tendencies on both sides, and a brother had displayed a tendency to regularly spaced attacks of alcoholism about every six weeks, and finally became absolutely uncontrollable. There seemed good reason to think that the case was a real example of ambulatory epilepsy, and that the lapse of memory claimed by the patient really existed.
In these cases it is usual for the so-called secondary personality to assert itself at moments of intense excitement, especially if they have been preceded by days of worry and fatigue and nights of disturbed rest. The secondary personality is not a complete personality, but is a manifestation of the original ego with the memory for past events as atabula rasa. It is well known that the memory is one of the intellectual faculties most dependent on physical conditions. It is the lowest in the scale of mental qualities and is shared to a very large degree by the animals. Injuries to the head not infrequently produce lacunae in the memory. These lacunae often have very striking limitations. It is not an unusual thing to find that old people remember events of their very early childhood better than things that have happened within a few years. Still more interesting is the fact that languages learned in youth may continue to be easily used, when those that were learned later in life, though perhaps known better than the previously studied languages, are forgotten.
It has often been noted that people who suffer from apoplexy may have peculiar affections of their memory. This may include such striking peculiarities as the forgetting of the uses of things, though their names are retained, or more commonly, the forgetting of names while the knowledge of uses remains. The one form of memory disturbance is called "Word Amnesia;" the other is called "Apraxia." It is on{264}record that a person suffering from a hemorrhage in the brain has lost completely the use of a language acquired later in life, though the memory of the native language, long since fallen into disuse, was perfectly retained. One apoplectic woman patient who had left Germany before she was ten years of age, and who had lived in America until she was fifty, forgot absolutely the English she knew so well and had to set herself to work to learn it over again, though her German came back to her very naturally. These are wonderful peculiarities of memory-pathology that show how much this faculty is dependent on the physical basis of mind and upon the cellular constituents of the brain.
It is not surprising, then, to find that lapses of memory may occur and that, as a consequence, so many of the facts that ordinarily enable us to identify ourselves as particular persons may be in abeyance. That apparently a secondary personality asserts itself,—though not in the sense that there is ever another ego present, another mind or another will,—practically all experts in psychology and nervous diseases are now ready to concede. There are, however, involved in this question a number of important problems of responsibility that have not as yet been entirely worked out, and with regard to which prudent persons are withholding their judgment. Each case must be studied entirely on its own merits, with a leaning in favour of the criminal or patient, in case there are evidences in past life of serious disturbances of mentality, though only of very temporary nature, or if there is a strong nervous or mental heredity.
The notion of the possibility of a secondary personality asserting itself is a much older idea than it is usually thought to be. When Stevenson wroteDr. Jekyll and Mr. Hyde, the immediate widespread popularity of the book was not due to recent psychological studies on dual personality and popular interest in a rare but striking mental phenomenon, but rather to the traditional feeling, long existent, of the possibility of two personalities in almost any individual. The other law in his members, of which St. Paul speaks, is an expression of this feeling, and its recognition was not original with him since it is after all a phenomenon at least as old{265}as the existence of conscience. It is one of the basic ideas in religious feeling. Nearly everyone has something of the consciousness that there is in him possibilities for evil that somehow he escapes, and yet the escape is not entirely due to his own will power. There is here the mystery of temptation, of free will and of grace as the drama of conscience works itself out in every human being. At times the evil inclination seems to get beyond the power of the will and a period of irresponsibility sets in. Needless to say, the adjudication of how much may be due to the habitual neglect of repression of lower instincts is extremely difficult, and this constitutes the problem which the alienist must try to solve. In the meantime there is need in many mysterious cases where secondary personality may play a rôle, of the exercise of a larger Christian charity than that hitherto practised. Pretenders may succeed in deceiving only too often, but in the past not a few innocent individuals have been held to a responsibility for actions for which they were not quite accountable.
JAMES J. WALSH.
{266}
Not unlike that condition which develops as the result of so-called psychic epilepsy, in which patients perform apparently voluntary acts, while the mind is really clouded by an epileptic attack, are those states in which, as the result of a more or less blind impulse, acts are performed for which the responsibility of the individual is at least dubious. Modern experts in nervous and mental diseases have sometimes spoken of these states as obsessions. This term is adopted from the older writers on mysticism who used it to designate states of mind in which an individual was under the influence of some spirit, though his intellectual and volitional state was not as completely under the subjection of this spirit as in the condition of possession.
It seems clear to the modern student of these obscure conditions that the old mystics and the modern alienists practically talk about the same state of affairs when using this term. As the result of obsession, mystical writers would have conceded that responsibility is not quite complete, though it is not entirely done away with. The modern alienist is just as sure of the diminution of responsibility, though he considers it due to the fact that for some physical reason the will is not able to act or prevent action as it is under normal conditions. The will is sometimes spoken of by certain of these modern psychologists as mainly an inhibitory faculty, that is, a faculty which prevents certain reflex acts from taking place, though permitting one set of reflexes to have its way. Under the influence of an obsession or, as the French call it,une idée obsédante, this inhibition is not{267}exercised and as a result an action is accomplished which the agent may very shortly afterwards regret exceedingly.
There is no doubt that impulsions or impulsive ideas may push an individual into the performance of an action which his reason condemns. Uncontrollable anger is a well recognised example of this. Impulses of other kinds may exercise just as tyrannic a sway, though it is harder to recognise the elements that make up the mental condition in other cases. Of course it may well be said that man must control his impulses. It is, however, just such impulses as can not be controlled that lessen responsibility and sometimes seem entirely to destroy it. It would, without doubt, be very easy to advance the uncontrollable impulse as an excuse for many criminal actions. In fact, the discussion of responsibility and its limitation by impulse would seem to be open to so many abuses as to make it advisable, in the present indefinite state of our knowledge, to put the subject aside entirely. The argument, however, from the abuse of the thing, does not hold, and an effort must be made to get at the truth concerning certain mental conditions which modify responsibility.
It is generally conceded that no two men are free in quite the same way with regard to the actions which they may or may not perform. Allurements that are almost compelling for some individuals, for others have no influence at all. Some men are so under the influence of anger that irritation may easily lead them to the commission of acts for which they will be subsequently supremely sorry. This may even be the case to such an extent as to endanger their lives, yet they are not able to control themselves. Many men suffering from degeneration of the arteries of the heart have been warned, like John Hunter more than a century ago, of the extreme danger of a fit of anger, yet, like John Hunter, have succumbed to bursts of anger, notwithstanding the warning, because someone irritated them beyond their rather limited powers of endurance.
It is extremely difficult ever to come to any proper appreciation of the responsibility of a given individual from a{268}single act. Preceding acts, however, may very well give evidence of the state of mind and the tendencies to disequilibrium which may make an apparently normal individual irresponsible under trying circumstances. The only way to render this clear is to illustrate such conditions by a concrete case.
Not many years ago one of the large cities of this country was shocked, for one twenty-four hours at least, by the news that a business man had shot his partners and himself, while at a consultation in which the affairs of the partnership were being settled up, after legal dissolution had taken place. The man in question had paid some debts of the firm with his own personal checks, and without taking proper legal recognisance for the moneys paid. When the partnership had been dissolved his partners insisted that instead of obtaining credit for these payments he should, on the contrary, pay his share of these debts once more as a partner. The state of the evidence was such that his lawyers told him it would be useless to take the case before the court at all; there was nothing to do but pay the unjust demands. He went to the meeting of his partners with a certified check for the amount of their claims in his pocket. As he took out his pocket-book to pass it over to them he seems to have realised very poignantly the fact that he was paying money that he knew he did not owe, and that his partners knew he did not owe, and that they were evidently taking advantage of a legal quibble in order to cheat him. Evidently it was an extremely trying situation. It was too much for his mental balance and he took a revolver from his pocket, shot both his partners dead, and then shot himself.
Taken by itself it is extremely difficult to say anything about the responsibility of a man who commits an act like this. In ordinary life he was known as a clever business man; to his friends he was known to be rather irascible and impatient, but a fairly good fellow. He was known to have what is called an awful temper; he had, however, never committed any violent act before. It is possible, of course, that a man should give way to a fit of anger for the beginning of which he is responsible, and then do violence{269}much greater than he would justify himself for in calmer moments.
There was another occurrence in the man's life that seemed to throw informing light on his mental condition. When he first came to live in the large city in which he died he began paying attention to a young woman, and the young woman was informed by a friend that he probably had a wife living. The young woman investigated this by putting the question directly to him. He denied it at once, wanted to know the name of her informant, and finally laughed the whole matter out of her mind. Within a week after his marriage to her, while on their wedding tour, he was arrested, charged with bigamy at the instance of his first wife, and it became evident at once that the charge was well substantiated.
Here is a man, then, who twice at least in life, when put in the presence of trying conditions, goes on to do the irretrievable, though the act is eminently irrational.
With regard to the murder and suicide it is said that he had talked to friends of shooting the scoundrels who were cheating him, but had been persuaded of the utter foolishness of any such idea. He had apparently given it up entirely. Notwithstanding this, he went to the last conference with his former partners with a loaded revolver, as well as the certified check for the amount of their claim. In the case of his bigamous marriage, notwithstanding the warning that his second fiancee's questions must have been, he followed out his preconceived idea of marrying her, though he must have realised in saner moments that discovery of his double dealing was inevitable. In a word, he was a man who, becoming dominated by an idea, an obsession it may be called, to do something, could not get away from the sphere of its influence even though it might be made very clear to him it was eminently irrational to follow out the idea.
There are many such individuals, and only the knowledge of their previous career enables us to desume the responsibility for their acts under trying conditions. That they are not responsible in the ordinary sense in which the logical, timorous mortal is who is at once repelled from such modes{270}of action seems very clear. Their lack of responsibility is manifest, at least to a degree that makes it easy for charity to find excuses for their crimes because of fatal flaws of character, the result of physical defects and faulty training, which make themselves felt especially at the moments that try men's souls.
JAMES J. WALSH.
{271}
In recent years no little attention has been devoted to the subject of criminology, and a supposed science of the criminal has been evolved. It has been the claim of a very well known Italian school of mental diseases, whose leader is Professor Lombroso of Turin, that there is a criminal type in humanity, that is, that there is a generic human organisation not difficult of differentiation, at least as a class, the members of which almost necessarily develop criminal proclivities. Even when criminality has not actually occurred, this is thought to be but an accident, and criminal acts may be looked for at any time from these individuals. Lombroso's claims in this matter have met with decided opposition in every country of Europe and also here in America. This opposition has come especially from serious students of abnormal types who have devoted much time to the study of criminals and other supposedly degenerate individuals. Magnan, the very well and widely known French authority on insane peculiarities, especially the so-called criminal monomaniacs, and whose opportunities for careful investigation of such cases in the Asile St. Anne in Paris have been very extensive, utterly rejects the idea of a special physical conformation as characteristic of the criminal.
He is not the only one of the distinguished authorities in mental diseases who is in opposition to Lombroso in this matter. Dr. Emile Laurent, the eminent criminologist of Paris, has shown that the same anomalies which are supposed to characterise criminals are to be found among those who have never committed any criminal act, and that these supposed signs of degeneracy are not sufficient to indicate even{272}that there are criminal tendencies. Manouvrier, the distinguished anthropological authority of the University of Paris, does not hesitate to advance the opinion that he can not find any distinctive difference between criminals and normal men in the extensive studies of the comparative anatomy of the two classes. He admits, however, that environment sometimes leads to the formation of habits which modify the anatomy in certain ways, and that of course traces of hard work, as well as of poor living, can be found in the anatomical conformation of many habitual criminals.
Dr. von Holder, a distinguished German authority on the subject, says that it is impossible to draw any conclusion from cranial asymmetries as to psychical characteristics, and that physical signs of degeneration indicate nothing further than the possible presence of a tendency to psychic degeneration. Dr. Wines, quoted by Draehms in his book onThe Criminal, a Scientific Study, says that in a strictly scientific sense, the existence of an anthropological criminal type has not been proved, and it is doubtful whether it ever can be proved. Dr. Arthur McDonald, the well known American specialist in criminology and degeneracy, some of whose work in connection with the National Bureau of Education at Washington has attracted widespread attention, says, in hisAbnormal Man:"The study of the criminal can also be the study of a normal man, for most criminals are so by occasion or accident, and differ in no essential respect from other men. Most human beings who are abnormal or defective in any way are much more like than unlike normal individuals."
How much the subject of criminology has been overdone because of the morbid popularity of the idea that many persons are, as it were, forced by their natures into the commission of crime, can best be appreciated from some recent publications with regard to left-handed individuals. A number of supposed observers, much more anxious, evidently, to make out a case for a pet preconceived theory, than to make observations that would add to the present store of truth, have rushed into print. As a result, left-handed persons have been said to be criminals much more commonly than{273}those who habitually use their right hand, and have also been said to be defective in other ways. They were spoken of as weaklings, degenerates, and the like. Statistics even were quoted to show a much larger proportion of criminals than might be expected, according to the normal percentage, between right-handed and left-handed people, among those who use their left hand by preference. As a matter of fact, left-handed people are far from being the weaklings or degenerates they are thus proclaimed; but on the contrary are often magnificent athletes and excellent specimens of normal development. Left-handedness is due to right-brainedness and this is an accident dependent on a diversion of blood supply in an increased amount to this side of the brain in early embryonic life. This question of the criminal and the left-handed individual and their mutual relations is only a good example, then, of how far over zealous advocates of a theory have been led astray in their attempts to bolster it up.
Draehms, whose opinion on the supposed born criminal is worth while quoting, as it is founded on his personal experiences and observations while a resident chaplain of the state prison at San Quentin, California, says:
"Crime is not, as Lombroso and his coadjutors would have us believe, wholly either a disease or a neurosis in the sense of a direct, absolute, physiological, pathognomonic entity, though doubtless not infrequently closely associated with physical, anatomical, and nerve degeneration, as above conceded. To presuppose absolute and necessary brain lesion or diseased nerve action, or anomalous, physiognomonical, or anatomical diathesis, as the inevitable precursor of any form of mental and moral deflection, is an assumption wholly unwarranted and is nowhere substantiated by facts, though its advocates have sought to lay their foundations deep and wide in the materialistic hypothesis. Most criminals present unusually sound physiological conditions, and there is among them no unusual death rate, considering their habits and mode of life, as we shall hereafter see. Hence their moral instability can not be associated with physiological instability in the absolute sense. The physical defect must be either reversionary or incidental, rather than absolute."
{274}
The impetus in the study of criminals, which came as a result of the revolutionary teaching of the Italian school, has not been without a good effect. Criminals all over the world have been studied more closely and more sympathetically, in order to test the new ideas, until now it is possible to draw definite conclusions with regard to certain features of the problem. After a time, Lombroso came to admit that the so-called criminal type occurred in somewhat less than half the criminal cases. Criminal anthropologists, however, have shown that the physical conformation called by the name criminal, is really only the result of a defective or degenerative physical constitution. It is easy to understand that persons born with a defective nervous system, or with serious degenerative lesions in other parts of the body, which prevent the proper nutrition and functional development of the nervous system, would perform many more materially criminal acts than the rest of the population. The idiot and certain forms of the degenerative insane show this. Any defective development of the nervous system, moreover, may lead to instability of moral character, because the free action of the soul may be hampered by the physical environment with which it is associated.
Certain of the physical peculiarities most frequently seen in criminals have an influence of this kind and merit discussion. A knowledge of them will furnish clergymen with reasons for a larger charity to those unfortunates, and a greater tolerance for their relapses, without allowing sentiment to play too important a rôle in dealing with them. There are all grades of defective human beings, from the idiot up to those little less than normal. Anatomical peculiarities prevent the proper functions of the nervous system, as it is not hard to understand. The will is hampered in its action by the defect of the instrument through which it must work.
In persons properly to be considered as degenerates usually the head is small, though this may not be very noticeable because of over-development of the jaws. A heavy lower jaw particularly, because of the principle of bone-development that size depends on functional action and reaction, may lead to over-thickness of the skull at the point of articulation. The{275}jaw articulates with the base of the skull, and as a consequence the cranial capacity of these individuals is distinctly less than normal. Besides this, there is commonly some abnormality in the shape of the head, or the cranium is distinctly asymmetrical. It has been noted that criminals have a large orbital capacity, that is to say, the bony framework surrounding the eye is so large as to encroach much more than usual upon the space left within the cranium for nervous tissue. The bones of the skull are likely to be thicker and heavier than usual, thus also limiting the cranial capacity. The superciliary ridges often project and give the beetling brow that is sometimes so remarkable. The jaws are heavy, and especially the lower jaw is apt to be large and prognathic, that is, projecting. This may extend even to the existence of a so-called lemurian appendix of the jaw. The zygomatic process is apt to be prominent, in keeping with the heaviness of the upper jaw. The nose is usually somewhat flattened, and may be crooked. This peculiar development of the nose puts most of the internal parts of that important organ within the skull itself. This further encroaches upon the cranial capacity. The ears are asymmetrical, often unevenly placed at the sides of the head, sometimes adherent at the lobule, sometimes very prominent. The displacement of the soft tissues is due to the existence of asymmetry of the skull. As may be seen, all of the characteristics of the criminal type, pointed out by Lombroso, may practically be summed up in the one expression, there is diminished amount of intracranial space.
With regard to many cranial deformities, and especially various thickenings of the cranial bones, it must not be forgotten that they are not the expression of physical heredity, but are often pathologically acquired. Certain diseases of children are accountable for many of them. Various disorders of nutrition in the early years of life express themselves in bony deformities, and the skull is not spared. Rickets, for instance, is well recognised as a cause of such deformities. Owing to a wrong etymology of this word, by which it is supposed to be derived from the Greek word, meaning the spine, rickets is sometimes scientifically{276}called rachitis. The connection, then, between the cranial deformity and some underlying nervous disturbance might be assumed. It does not exist, however. Rickets is an English word, the derivation of which is unknown, but probably it iswricken, twisted, deformed, and its use has crept in because the disease was first described in England, and is indeed often spoken of on the continent of Europe as an English disease. Not that it is any more frequent in England, however, but was there first recognised as a distinct pathological entity. As the result of this affection the children, usually of poor parents, suffer from gastro-intestinal disorders of various kinds, and develop symptoms of malnutrition, affecting especially bone tissue. The ends of the long bones at the wrists and at the ankles, where the effects of the disease can be noticed particularly, become more thickened and nodular than usual. The ends of the ribs, where the bones join the cartilages, also become nodular, so that a series of beads can be seen down each of the child's sides, a condition described as the rickety rosary. In a similar way the bones of the skull become thickened, especially at the edges of the fontanels, that is, the openings in the child's head before complete ossification of the skull has taken place. As a consequence of this thickening these openings do not close as they should, and the head becomes markedly deformed in some cases.
Indeed, as has been shown by experts in children's diseases, many of the peculiarities that have been pointed out by over enthusiastic craniologists as indicating criminal degeneration, are really the results of the rickety process on the skull. Needless to say, however, this does not change the character of the individual, nor is there any good reason why such deformities should have any special connection with criminality. It happens that many of the criminal classes suffer from malnutrition in their early childhood, and as a consequence there is a faulty bony development of the skull. It is observations of this kind, particularly, that have served to discredit craniology as an independent science.
With regard to habitual criminals, the question of criminality must be discussed from the standpoint, not of those who theorise, but of those who know from actual{277}observation most about the criminal classes. In an article inThe Nineteenth Century and Afterfor December, 1901, Sir Robert Anderson discusses how to put an end to professional crime. Sir Robert has been Chairman of the Criminal Investigation Committee of the English Parliament for many years. His opinion, then, is worth weighing well and is very strikingly different from those of the criminologists who would find a very large proportion of criminals among mankind. He says:
"I am not turning phrases about this matter, or dealing in rhetorical fireworks. I am speaking seriously and deliberately, and I appeal to all who have any confidence in my judgment and knowledge of the subject, to accept my assurance that if not 70,000 but 70 known criminals were put out of the way, the whole organisation of crime against property in England would be dislocated, and we should, not ten years hence but immediately, enjoy an amount of immunity from crimes of this kind that it might to-day seem Utopian to expect. The criminal statistics cult blinds its votaries. It is the crime committed by professional criminals that keeps the community in a state of siege. The professional criminals are few and I may add they are well known to the police. The theory that these men commit crimes under the overpowering pressure of habit, or of impulse, is altogether mistaken. They pursue a career of crime because, as Sir Alfred Wills expresses it, they calculate and accept its risks. And just in proportion as you increase the risks you will diminish the number of those who will face them. True it is that the army of crime includes a certain number of wretched creatures who have not sufficient moral stamina to resist the criminal impulse. I believe there are fewer of this class in England than abroad, but I know that these are not the sort of criminals whose crimes perplex the police. The high-class criminal is a different type of person altogether."
Sir Robert gives an extract from one of the morning papers of the day on which he wrote these lines, in order to show how different is the status of every ordinary habitual criminal from that which the enthusiastic criminologist supposes it to be:
{278}
"Hewson Patchett, 48, was sentenced yesterday for obtaining seven pounds and a gold watch by false pretenses. He urged it was his first offence, but a London detective informed the court that there were about two hundred cases against him for housebreaking."
Sir Robert adds: "If Patchett is a cool-headed, deliberate criminal, the whole proceeding is a farce. And if he be one of those miserable, weak creatures who can not abstain from crime, the sentence is barbarous."
Such experiences as Sir Robert hints at as occurring frequently in England, are certainly by no means uncommon in this country. Within the past year in at least four cases in New York City, in which a burglar, besides committing robbery, wounded or killed some one, either in the commission of the crime itself or in endeavouring to avoid arrest afterwards, there were more than two convictions registered against the criminal in his previous life. There can be no doubt that criminality becomes for some men a sort of mania, and that society must protect itself against their actions quite as it does against those of the insane by confining them under surveillance. It seems very clear that while a man may, under stress of circumstances or because of some specially tempting opportunity, be induced to commit burglary or some other crime by violence in order to obtain money, this will not happen a second time, except in the case of certain individuals whose moral tone is so perverted that reformation is practically hopeless. If a second conviction for burglary, therefore, is secured, a longer sentence than is now the custom should be inflicted, and the individual should not be allowed to go from under the surveillance of the authorities until he has demonstrated, for at least five years, his willingness and capacity to earn an honest living.
This may seem a drastic method. It may also appear to some that there would be consequent upon this system of regulating criminals a very undesirable increase of our present rather extensive system for the care of criminals. Here is where Sir Robert Anderson's experience is of value. The confirmed criminals are not near so many in number as is usually supposed, or as is even claimed by certain heedless{279}statistical experts in criminology. There is no doubt, however, that these men succeed in drawing others around them and in organising most of the crimes of violence that are committed. There is a certain glamour about the successful burglar that allures the young man and starts him in the downward path of criminal tendencies from which he may not be able later easily to withdraw.
If those who are most deeply interested in the reform of the criminal classes would unite in an effort to secure legislation to the effect that the habitual criminal should receive, not a definite sentence but an indeterminate sentence; that is to say, that on his second conviction for burglary, he should be sent to jail until such a time as, in the opinion of officers of the institution where he has been confined, he shows signs of a disposition to become a worthy member of society, and that then he should be allowed to be at liberty only under such circumstances as would permit of reports with regard to his conduct for a time equal at least to the years spent in prison, then there would be much less need of the theoretical considerations with regard to the heredity of criminal traits, and the supposed all powerful influence of environment in fostering criminal tendencies. There is in this matter a very worthy field for the development of philanthropic qualities, and the student of the abnormal man will find many opportunities for the exercise of a large-hearted charity, rather than the facile condemnation which places all violations of law under the head of criminality.
Those who have made special studies with regard to criminals have, as a rule, come to the conclusion that our modern method of treating those convicted of crime is eminently irrational. It is a rare thing to pick up a newspaper without finding that a crime by violence has been committed by some one who has previously been in state's prison for a similar crime. Most of the burglars have a police record. Pickpockets and others continue to pursue their avocations, notwithstanding a series of convictions. It is clear that a sentence of a year or two, or even more each time that a crime is committed, does not act as a deterrent. Such people are differently constituted from those who are influenced by{280}public conviction of crime and restraint of liberty. There is something radically wrong with their moral sense. It would seem that the proper way to treat them is after the same fashion as the method used with those who are mentally impaired.
After a man has shown, by a second conviction of a crime by violence, that he is one of those whose moral sense can not be restored by punishment to a realisation of his action, then an indeterminate sentence, somewhat as in the case of the mentally unstable, who are allowed to leave the asylum but are kept under observation, is the only proper method.
Men like Sir Robert Anderson are sure that this procedure could be adopted with regard to quite a liberal number of leading criminals whose influence induces others to crime. There would be much less need for all machinery of the criminal law than at the present time, and the community would be better protected. This is certainly true as regards the large cities, where crimes against property are almost without exception committed by those who have been previously convicted for such crimes, or who at least have been in intimate association with such convicted criminals.
This view of the criminal, as one against whom society must protect itself just as it does against the insane, is comparatively modern. It must be borne in mind, however, that insane asylums are by no means an old institution, and that the present restraint of very large numbers of the insane is something unknown before in history. It seems not unlikely that if this newer aspect of criminology could be made popular great benefit would follow, not only to the peace of the community and the freedom of its members from fear as to such crimes, but also a number of the weaker individuals, who are now influenced and led astray by clever criminals, would be saved from commission of crime and the necessity of punishment, with the degradation and lifelong stigma that this involves.
This is an aspect of criminology with which the Christian clergyman can be in sympathy, and that does not smack of the utter materialism which was at the foundation of much of the discussion of the so-called criminal type. The{281}recognition of moral perversion as a form of insanity requiring treatment and then constant observation for many years, just as in the case of mental disequilibration would be a distinct advance over our present crude methods of dealing with criminals.
JAMES J. WALSH.
{282}
Of late years the crank, in the various forms in which he or she may occur, has became a subject of great popular as well as scientific interest. As a matter of fact, the queernesses of people are a more absorbing study to the neurologists and psychologists than are any forms of insanity. It not infrequently happens that individuals of peculiar tendencies are prone to have special affinity for religious ideas, and strange applications of Christian formulae of thought. Even when they do not become absolutely insane in their religiosity, they may often go to extremes. It must be remembered, too, that some cranks are mentally affected in but mild form, and it may be difficult to determine whether their oddity is really the result of a certain amount of mental torsion, or merely intellectual tension.
Such persons are more likely to be brought in close contact with their pastors and other clergymen and with religious Superiors of various kinds than even normal individuals. They often put their confessors, particularly, in serious quandaries in the matter of spiritual advice. A review, then, of the accepted ideas of experts with regard to such people is likely to be of special service to those who would understand these cases as well as possible, though the present state of medical knowledge, here as elsewhere, leaves much to be desired.
A distinguished authority in mental diseases once said, half in jest though he meant it to be taken at least half in earnest, that a great many more of us are cracked than are usually thought to be, only that most of us succeed in concealing the crack quite well. The frequency of the crank adds to the{283}interest of his study, which is by no means a department of medical science of recent growth. While interest in this class of persons has become much more intense in recent years, eccentric individuals have been an object of close observation and of serious study almost as far back as history goes. When Quintilian said that genius was not far separated from insanity, he meant to record the conclusion of his time, that men of genius are apt to seem inexplicable in their ways to those who come closely in contact with them. Eccentric persons, however, are by no means always undesirable members of a generation. It has been noted by historians in all ages that to the refusal of eccentric individuals,—often thought at the beginning, particularly, to be little better than insane—to accept the traditions of the past, we owe many of the privileges which we enjoy at the present time. Their refusal to think along old lines of thought often makes them valuable pioneers in progress.
Definite knowledge with regard to the pathological basis of crankism, or eccentricities, has not yet been obtained. What has been learned, however, has enabled the neurologist to distinguish various forms of mental perturbation, to recognise the probable influence of certain conditions and environments on the future action of eccentric individuals, and to foretell the probable outcome of the cases. All of this information is of very practical importance to religious Superiors and others in positions of religious confidence, who are sure to be brought, even more than the rest of the community, in contact with the eccentric class. It has seemed advisable, then, to condense some of the recent knowledge on this subject into popular form for the use of confessors, spiritual directors, and those in religious authority.
How recently medical knowledge on this important subject has developed along strictly scientific lines may perhaps best be appreciated from the fact that Professor Mendel of Berlin, to whom we owe the termparanoia, the recognised scientific designation for crankism, is yet alive and continuing his lectures on neurology at the great German university. The term, from the Greek word, meaning alongside of, and{284}, mind, expresses the fact that the mental faculties of individuals designated by it are beside themselves, that is, the mental powers are not entirely under the control of the individual, so that they only come near voluntary intellection in its highest sense. In a word, the term contains a series of expressive innuendos by its etymological derivation.
Professor Berkley of Johns Hopkins University says that the word paranoia was first adapted by Mendel from the writings of Plato, to indicate an especial form of mental disease occurring in individuals capable of considerable education, at times of brilliant acquirements, yet possessing a mental twist that makes them a class apart from the great mass of humanity.
Professor Peterson, the President of the New York State Commission of Lunacy, gives a very good definition of the condition which, though couched in somewhat technical terms, furnishes the most definite idea of the essential properties of paranoia. He says: "Paranoia may be defined as a progressive psychosis founded on a hereditary basis, characterised by an early hypochondriacal stage, followed by a stage of systematisation of delusions of persecution, which are later transformed into systematised illusions of grandeur." He continues: "Though hallucinations, especially of hearing, are often present, the cardinal symptom is the elabourate system of fixed delusion."
In a word, the paranoiac is a crank usually descended from more or less cranky ancestors, with an overweening interest in his health to begin with, who later develops the idea that many people are trying to do him harm, or at least to prevent his rise in the world, and who finally becomes possessed of the notion that he is "somebody," even though those around him refuse to acknowledge it and pay very little attention to the claim. Such people not infrequently hear things that are not said. That is, not only do they hear the voices of the dead, of spirits good and evil, but also the voices of living persons, who are at a distance from them and sometimes even when those living persons are present, but have said absolutely nothing. These delusions of hearing, however, are not so important as the self-deception forced upon them by their{285}mental state with regard to their importance in the world and their relations to other people.
The most significant consideration with regard to paranoia is the fact that it is practically always hereditary. Krafft-Ebing said that he never saw a case of true and reasonably well developed paranoia without hereditary taint. This does not imply, of course, that the same symptom of delusions exists in several generations, but some serious mental peculiarity is always found to exist in the preceding generation. Other authorities are not quite so sweeping in their assertion of heredity for these cases, though practically all are agreed that in over 80 per centum of the cases, some hereditary element can be traced without overstretching the details of family history that are given.
Paranoia occurs a little more commonly in females than in males. As it is of hereditary origin, it is not surprising to find that the peculiarities are noticed very early in life, though they may not be sufficiently emphasised to attract the attention of any but acute observers, who are brought closely in contact with the patients. Even in childhood, patients who subsequently develop serious forms of paranoia, usually have been shy, backward, inclined not to play readily, irritable, peculiar, precocious, prone to spend much time in study at an age when they ought to be interested mainly in sports, and they are generally old beyond their years. A typical example of this was Friederich Nietzsche, the German philosopher, who died a few years ago in an insane asylum.
Olla Hanssen, Nietzsche's biographer, who carefully collected the family accounts of the philosopher's childhood, said that he did not talk until much later in childhood than is usual. "As a boy he was retiring and solitary in his habits. During his school days he was always interested in books not in sports, in lonely walks not in young companions." A history of this kind will be found in the early career of many queer folk. Very often these old-fashioned traits are a source of pleasure to parents and sometimes even to teachers. During childhood, however, the sports of childhood should satisfy the child, and abnormalities of interest in things outside of childhood's sphere are always suspicious. The growing{286}organism needs, first of all, muscular exercise, and after that the freedom of mind that comes with spontaneous play. It may be said, in passing, that the walk of a city child with its maid, when even the child's choice in the matter of where it shall walk is not consulted and the maid's will is constantly imposed, is the worst possible training for spontaneous action or volition in later life.
In the cases that develop early in life it will practically always be found that infantile cerebral disorders of some kind are a prominent feature of the history. The mother's delivery was difficult perhaps, and the child was for some time after birth unconscious, or infantile convulsions occurred. It may be remarked here that a history of convulsions in childhood is now considered by physicians as of serious import for the future nervous and mental life of the child. It has recently been announced, for instance, that so-called idiopathic epilepsy,—that is, epilepsy without some directly immediate cause,—very seldom develops later in life in persons who have not had in childhood convulsive seizures as the result of some extreme irritation. This does not imply that every child that has convulsions will suffer from some serious nervous or mental condition later; but every child whose mental and nervous equilibrium is not stable, because of hereditary elements of weakness, will almost certainly suffer. Injuries to the head in childhood are nearly of as great importance as the actual occurrence of convulsions.
There are usually three stages of paranoia described by authorities in mental diseases. These have been called the prodromal or initial period, which is also, because of the set of symptoms usually most prominent in it, often called the hypochondriacal stage of the disease. The patient occupies himself with his feelings and his sensations. He is concerned very much about the state of his health and is prone to think himself affected by diseases that he reads about or hears described. This set of symptoms, by itself alone, is not an index of enduring mental disturbance, but may be only a manifestation of a passing mental perturbation in sympathy with some slight physical ailment. This state may indeed be nothing more than the result of too persistent introspection.{287}Most medical students suffer from a certain amount of hypochondria during their early acquisition of a knowledge of the symptoms of disease.
In the true hypochondriac, however, every bodily sensation, or as it is technically called, somaesthetic sensation, is translated to mean a significant symptom of serious disease. A slight feeling of fatigue becomes to the patient's mind the "tired feeling" of a dangerous constitutional disorder. Any peculiar feeling, such as that of the hand or foot going to sleep, is set down at once as a symptom of a serious nervous disease, or if the patient has heard that in old people numbness of the extremities is a forerunner of apoplexy, he is sure to conclude that apoplexy is threatening in his own case. Subjective sensations of heat and cold set him to taking his temperature and his pulse, and even slight variations in these are magnified into important physical signs of disease.
Very often such slight symptoms as passing lapses of memory are magnified into approaching complete failure of memory, and lassitude becomes a permanent loss of will power, evidently due to disease in the patient's mind, and there begins the persuasion that nothing can overcome it. Morbid introspection becomes, after a time, the favourite occupation, and every slightest sensation or feeling sets up trains of thought that lead to far-reaching conclusions with regard to physical weakness. The patient is apt to be greatly preoccupied with himself, to neglect his duty towards others, to be utterly selfish, to fail to realise how much sympathy is being wasted on him.
Some people never pass beyond this preliminary stage of the mental disorder. Usually, however, after a time the patient misinterprets not only his own sensations, but the actions of other people in his regard; he becomes suspicious and distrustful of everybody around him, sometimes even of his best friends. He is passing on to the second stage of the disease, in which he is sure to feel that he is the object of persecution. Just as he misunderstood his physical symptoms, so he misconstrues the actions of his friends. He is sure that they look at him curiously, that they smile{288}ironically. Sometimes he thinks that they wink at one another with regard to him, or make signs behind his back that are meant to be derisive. Even harmless passing observations may be morbidly perverted into severe and inimical criticism of himself and his actions.
The paranoiac is now apt to enter fully upon the second or persecutory stage of his mental disorder. His distress and discomfort he attributes to those around him and he is sure that he is the subject of persecution. At first his persecutors are not very definitely recognised. No particular person is picked out and even no particular set of persons. There is just a vague sense of persecution. A distinguished neurologist once said that no sane person in this world, outside of a novel or a play, has time to make it his business to persecute anyone else. When people come, then, with stories of persecution, either they themselves are not in their right mind and are deluded as to the source of the persecution, or else their persecutor is not in his right mind and the case needs seeing to from the other standpoint.
After a time, longer or shorter in individual cases, the paranoiac begins to recognise definitely who his persecutors are. As a rule, it is not some single individual, but a combination of individuals. Already there is the beginning of the third state of the disease—the grandiose stage of the disease, in which the patient feels an extreme sense of his own importance. It would be derogatory to his self conceit to consider himself the subject of persecution by an individual, and so it is usually some society, or the government, or its officials, or some secret organisation that is persecuting him, and perhaps also persecuting those who are near and dear to him.
Sometimes it is the Odd Fellows, or perhaps the Masons, who are the persecutors. If the newspapers have recently had some account of the disappearance of Morgan years ago, and this subject crops up periodically in the papers, then the Masons become a favourite subject for paranoiacs' delusions of persecutions. Just after the Cronin murder in Chicago, the Clan-na-Gael became an extremely fearsome spectre for paranoiacs who thought themselves persecuted. It is of some{289}importance to know, as a rule, what the usual reading matter of a patient is, and what things are likely in his past history to have impressed him, in order to realise what the real source of his delusions of persecutions are.
It is curious how rational these patients may be on all other subjects except the special topic of their delusion. During the past year a paranoiac has been under observation, who is considered a reasonably rational individual by those who know him well, who follows his daily occupation, that of clerk, without intermission and with business ability, who is a faithful attendant at church, and who is very kind to his family, but who is sure that he is the subject of persecution by the Clan-na-Gael. He never belonged to the organisation. He is not able to give any good reason why he should be persecuted, except perhaps the fact that, though an Irishman, he never did belong to them. He is perfectly sure, however, that they are planning to poison him and his family. He finds peculiar tastes in the tea and the coffee at times. He throws out these materials and insists on his wife getting others at another grocery store. He sometimes brings groceries home from a distance and yet finds that if he ever buys materials a second time in the same place, they are sure to have been tampered with in the meantime by emissaries of this secret organisation. He feels sure that he has seen these secret agents, but he is only able to give vague descriptions. Not a little of the prejudice against these organisations is really founded on such morbid suspicions.
Another form that the idea of persecution sometimes takes, in this second stage, is the delusion that the patient is neglected by those who should specially care for him or her. A woman insists that she is neglected by her husband. She may become intensely jealous of him and make life extremely miserable for him without there being any good reason for her jealousy. These cases are not nearly so rare as might be thought. On the other hand, men suspect their wives of unfaithfulness. This suspicion may go to very serious lengths in persecution at home, though the man all the time keeps his suspicions to himself, in order not to make a laughing stock of himself outside of the house. It is this curious mixture of{290}rationality and delusion that is the characteristic feature of the disease. It is for this reason that these conditions were sometimes called monomanias, as if patients were really disturbed only on one point. As a matter of fact, however, patients are mentally wrong on a number of points, though there is some one mental aberration so much more prominent than other peculiarities that it overshadows the others.
It is not long after the persecutory stage sets in before patients are apt to become themselves persecutors of others as a result of their belief that they are being persecuted. The French have a suggestive expression for this. It ispersécutés persécuteurs, that is to say, "persecuted persecutors,"—patients who are trying to repay supposed persecutors by persecution on their own part. Such patients, of course, very easily become dangerous. They need to be carefully watched. As a rule, the persons whom they are prone to select as the persecutors upon whom they must avenge themselves are absolutely innocent parties. At times they are even dear and well meaning friends.
After the persecutory stage in paranoia, comes the third, or so-called expansive period of the disease. It has been remarked that sometimes this develops as a sort of logical sequence from the patient's ideas of persecution. If he has too many enemies and if important secret organisations are trying to be rid of him, he must be a person of some importance. As a consequence he evolves for himself a royal or aristocratic descent, or hints that he is the unacknowledged son of great personages. In a kingdom royalty is, of course, a dominant idea. In a republic like our own, he may consider himself to be the President or the politician to whom the President owes his office.
Paranoia Religiosa.—Not infrequently the first hint of their supposed greatness comes to such patients suddenly in a dream or in a vision; when their expansiveness takes a religious turn, this is especially apt to be the case. They may believe themselves to be especially chosen by the Almighty, a new Messiah or even Christ Himself, come once more to earth. Such people may retain much of their rationality on most of the points relating to practical life, and yet have this{291}hallucination as to their close relationship with the divinity. Not only may they retain their mental equilibrium on other points, but they may even give decided manifestations of great genius. This is, I suppose, one of the most interesting features of this form of mental disease, but it is well illustrated in the lives of many modern founders of religious sects, even in our own generation.
Such religious reformers as Mahomet and Swedenborg seem undoubtedly to have been afflicted with this third stage of expansive paranoia. In our own day there is no doubt that many of the founders of new religious sects, many of the heaven-sent apostles or reincarnations of patriarchs and prophets, the miraculous healers and the like, are afflicted in this same way. It is useless and entirely contrary to the known facts to put such people aside as mere imposters. Imposters they are, but they have imposed on themselves as well as on their followers. They are sincere as far as they go, and the mental twist that gives them their power has occurred in the midst of the manifestation of the intellectual faculties of a highly practical character and of executive ability, with wonderful capacity for the direction of complex affairs. A prominent neurologist said, not long ago, that the most interesting feature of Christian Science is to contemplate in the study of the movement how near people may come to insanity and yet retain their faculty to make and handle money and even accumulate fortunes.
Paranoia Erotica.—After theparanoia religiosa, the most common form of the disease is theparanoia erotica. There are authorities in mental diseases who do not hesitate to say that an excess of religiosity and of erotic sentimentality are more or less interchangeable. This declaration represents, however, the unconscious exaggeration of a mind unsympathetic towards religious ideas. But it must not be lost sight of that the two forms of excesses, erotic and religious, are more nearly related than would be ordinarily supposed, and that erotic manifestations may be confidently looked for in patients who have been afflicted by a too highly wrought religious sentimentality. St. Theresa seems to have realised this very well and has touched on the subject in one of her letters.