A. "Why, sure I am."

Q. "Did anything strange happen to you for which you can't give yourself an account?"

A. "No."

Q. "Do you hear voices talking to you?"

A. "Yes, hear you talking to me now."

Q. "Do you see any strange things?"

A. "No."

Q. "Do you ever have fits or convulsions?"

A. "No."

Q. "Did you ever try to commit suicide?"

A. "No."

Q. "Is there anybody trying to harm you in any way?"

A. "Yes, those black-hands anarchists."

Q. "How much money are you worth?"

A. "Nothing."

The foregoing two cases are representative of a group which unquestionably forms the most difficult part in the problem of caring for the insane criminals. Here we have a couple of individuals whose entire psychotic manifestations, if such they may be considered, consist of a most wild and vicious rebellion against imprisonment. They are individuals who cannot be kept under any prescribed mode of living, and when this is insisted upon, they react to it in an insane manner.

Bonhoeffer justly termed them "wild men", for wild indeed they are when in one of their tantrums. The question arises, "Wherein lies the cause of this rebellion against discipline?" It certainly cannot be wholly attributed to the environment, for these individuals behave in a similar manner even when removed to the far more lenient regime of a hospital.

We must seek an explanation for the behavior of these individuals in the individual himself, in his make-up.

Looking at the life history of the two foregoing patients we find them both to be of the most depraved cla.s.s of society. The one is a professional prost.i.tute; the other subsisting upon the earnings of a prost.i.tute. Their relation with man has always been characterized by a sort of vicious vindictiveness. Their high-strung emotional make-up brought them into serious conflict with those about them on many occasions before. Being finally taken hold of by the law and made to submit to a certain well-regulated mode of existence, their inherent characteristics a.s.sert themselves in a most decisive way and they react to the situation in the manner of a trapped tiger, stopping at no means to gain their point. The one commits a homicide during one of her outbreaks of pa.s.sion; the other risks his life to obtain his purpose, by jumping out of a moving train with his hands shackled. Their life seems to be one long series of impulsions, fostered and sustained by the extreme lability of their emotions. Intellectually they show no defect.

They are keen and alert to every opportunity which presents itself to them and are very shrewd in the execution of their criminal acts.

Finding themselves under a regime which exacts from them a certain submission to rules, to regulations, they begin to misinterpret ordinary occurrences in their environment in a sort of delusional manner: They are persecuted by the warden because the latter insists upon making them behave themselves; the keepers are a bunch of anarchists, whose entire occupation seems to be to persecute them and down them. This for no other reason than because they are made to work and to behave themselves. J. J. M. tells me that he will not behave himself, that he is not here to please anyone but himself and recognizes no authority other than that of Christ. The other says she raised so much h.e.l.l at the prison that they had to send her back to the hospital. The distinguishing feature of their psychotic manifestations is that they are provoked essentially by definite situations. They are not a mere wild, misdirected, meaningless series of insane acts, such as one would expect from a demented person, but distinct reactions to situations.

Refuse them a request and they at once become wild, abusive and vicious, smashing up everything that they can lay hands on; conversely, when granted some of their unreasonable requests, it serves at once to appease them for the time being at least. Their conduct, however, is very detrimental to the prison regime, as discipline cannot be maintained with such disturbing elements about. Their interpretations of discipline are considered as delusions of persecution, their outbursts of temper as typical maniacal outbreaks, and consequently they are shipped off to an insane asylum. Now the question arises whether we are doing our duty by society in declaring these individuals as irresponsible for their acts. In other words, should these individuals with marked and incorrectible criminalistic tendencies, be, so to speak, licensed to ignore the law in its entirety by giving them the protection of an insane asylum? Of course, from a broad, humane point of view, we must realize and appreciate that there is something distinctly wrong with these individuals, that their mental endowments are the essential factors which determine their behavior. On the other hand, we must not forget that these individuals fully realize that once they have been sent to an insane asylum, they are protected from punishment by law for all future time and they are ever ready to utilize this knowledge, as has been my experience with quite a number of recidivists, who somehow never get into an insane asylum until they are in the hands of the law.

The scope of this paper will not permit me to enter into an extensive discussion on the treatment of these cases. I will say this, however,--that we are very far from having solved satisfactorily the question of the care of this particular cla.s.s of insane criminals. As this paper is not primarily a discussion of the degenerative psychoses, I will refrain from reporting further cases. I believe I have shown by the preceding two cases that the mental disturbances of the degenerative individuals are essentially psychogenetic in origin.

REFERENCES

[1] VAN RENTERGHEM, A. W.: _Journal of Abnormal Psychology_, Jan.-Feb., 1915.

[2] KRAEPELIN, E.: "Psychiatrie." Achte Auflage. Leipzig, 1910. Bd. 1.

[3] REICH: "Ueber Akute Seelenstorungen in der Gefangenschaft."

_Allgem. Zeitschr. f. Psych._, 1871, Bd. 27, p. 405.

[4] MOELI: Ueber irre Verbrecher, 1888.

[5] GANSER: "Ueber einen eigenartigen hysterischen Dammerzustand."

_Archiv f. Psych._, 30, 1889.

[6] RAECKE: "Hysterischer Stupor bei Gefangenen." _Allgem. Zeitschr. f.

Psych._, 18. 409, 1901.

[7] RAECKE: "Beitrag zur Kenntniss des hysterischen Dammerzustandes."

_Allgem. Zeitschr. f. Psych._, 18. 115, 1901.

[8] KUTNER: "Ueber Katatonische Zustandsbilder bei Degenerierten."

_Allgem. Zeitschr. f. Psych._, 67, p. 363.

[9] SIEFERT: "Ueber die Geistesstorungen der Strafhaft." Halle a. S.

1907.

[10] BONHOEFFER: "Klinische Beitrage zur Lehre von den Degenerationspsychosen." Halle a. S. 1907.

[11] BRATZ: "Da.s.s Krankheitsbild der Affect-Epilepsie." _Aerzt.

Sachverst._ Berlin, 1907. XIII. 112-116.

[12] STURROCK: "Certain Insane Conditions in Criminal Cla.s.ses." _Journal of Mental Science_, 56. 1910, p. 653.

[13] BIRNBAUM: "Psychosen mit Wahnbildungen und wahnhafte Einbildungen bei Degenerierten." Halle a. S. 1908.

CHAPTER II

THE NATURE AND TREATMENT OF THE PSYCHOSES OF PRISONERS

Those who still believe in an exclusively materialistic theory of mental disorder must find it extremely difficult to maintain their doctrine in the face of the many incontrovertible facts brought to light through modern research in the field of psychopathology.

The modern trend in psychiatry is distinctly in the opposite direction.

We no longer today insist upon material changes in cells and tissues for every psychotic phenomenon, but rather endeavor to investigate mental life, be it normal or abnormal, from the biologic point of view. We are being constantly confronted with the undeniable fact that whatever may be the physical substratum of mental disorder, it does not aid us in understanding the peculiar expression which a given psychosis chooses to a.s.sume. Why it is that one paretic greets us with the exalted mien of his grandiose delirium, while another spreads about him the gloom of a depressive delirium--the changes in the pyramidal cells do not explain.

There must be, then, factors other than material ones which determine this.

Mental life, after all, expresses itself in a series of reactions destined to result in a proper adaptation to environmental conditions, and the causes which determine a given reaction may be psychic as well as physical in nature. Indeed, in the realm of psychopathology we see indubitable evidence of the predominance of psychic causes of mental disorder over physical ones, and the subject under discussion here further emphasizes this.

The problem of the prison psychoses, although extensively discussed in psychiatric literature in the last half century, is far from being solved, and for this and many other reasons deserves further attention.

The psychotic manifestations of prison life are of sufficient frequency to deserve some definite place in our nosological tables; they develop in a milieu artificially created by society, and if this milieu is responsible for the production of mental disorder, it is of the utmost importance, both from a preventative and curative standpoint, to investigate the causes operative here, and lastly, these psychoses concern individuals who form one of the most important problems society has to deal with, and any light which the study of psychotic conditions in these individuals may throw upon the general problem of crime and the criminal, should be very much welcomed.

I fully believe that in time the study of the psychotic phenomena developing in criminals will give us a correct insight into the nature of the criminal personality and thus aid in the solution of that problem which baffles criminologists today.

We know that while pure experimental psychology and psychopathology have aided us in understanding the human mind both in health and disease, we owe the bulk of our knowledge in this field to the investigations of Nature's phenomena and experiments. The human mind, the most complex and intricate organ, lends itself but very feebly to a.n.a.lysis when all its component parts work in unison, and it is only when through disease it has become, so to speak, disintegrated into its various units, that a more ready access to it becomes possible. This is being fully appreciated both by psychologists and psychopathologists. Mental medicine, however, if it is viewed from the present-day broad conception of the term, must not confine itself exclusively to psychotic manifestations in the strictest sense of the word, but should embrace within its realm that great ma.s.s of unfortunates who populate our prisons, poorhouses and reformatories. It is now being universally recognized that the pauper, the prost.i.tute, and the criminal cla.s.ses are primarily products of mental defect and degeneracy and as such must come within the purview of mental medicine. This being the case, the same truisms which apply to the insane in general must likewise apply to the above-mentioned types.