Chapter II: The Nature and Treatment of the Psychoses of Prisoners (2)

CASE II.--J. H., aged 37. Admitted to the Government Hospital for
the Insane, March 8, 1909. Maternal grandfather died suddenly from
unknown cause. Was a race-track operator. Father alcoholic. Mother
suffered from vertiginous attacks. There were twenty-one children in
the family, fifteen of whom died in infancy. One brother died of brain
tumor. One sister is neurotic; her eight year old son suffers from
congenital heart disease. Patient was born in Manchester, England. He
was the twentieth child; mother was over forty years old at the time
of his birth. He was an unusually small and puny infant and remembers
using crutches when a child. At seven he was bitten by a dog and
dragged about on the ground for a great distance; when finally
rescued was unconscious for a long time. No further ill-effects.
School life was characterized throughout by truancy and disobedience
and finally terminated in expulsion. At that early period of life he
already showed marked egotism, extreme vindictiveness and an utter
disregard for consequences. The immediate cause of his expulsion from
school was a fistic encounter with a teacher. At the age of eleven,
his family immigrated to this country. He states that he was different
from other boys of his age, did not care for the ordinary childhood
sports, and the only friends he had were a young sister and a dog. He
states that he couldn't get along somehow with the other boys, that he
often thought that the whole world was trying to down him and
persecute him. About that time someone stole his dog. He brooded over
this so much that he finally jumped into a creek, intending to commit
suicide, but was rescued by bystanders. He has made several other
attempts at suicide in later life. In describing these he elaborates
them with a lot of fanciful trimming, dilates on the importance of the
various situations attending them, and how much uproar they caused
among those who knew of them. At the age of fourteen he had a quarrel
with another boy. Upon being reprimanded by the latter's father, he
could not rest until he had obtained a gun and fired at the boy's
father while the latter was sitting at the supper table with his
family. In relating this incident he states with great vanity that he
fully intended to kill the boy's father; he wasn't going to be
insulted by anyone and let it go at that. Here was probably the first
well-illustrated instance of his pathologic emotionalism, the tendency
to a complete dominance of a certain affect. He was committed to some
sort of an industrial school for a year. Upon his release from there
he went to work in a machine shop in his native town. One day a couple
of gentlemen and a lady walked through the shop and stopped in front
of the machine on which he was working. He did not like this, became
angered, picked up the dog which followed them and threw it into the
oil tank which fed his machine. At sixteen he ran away from home. He
gives a history of an industrial career and apparently he had no
difficulty in learning a trade, and it is quite likely that he was a
skilled workman. His entire industrial career, however, is
characterized by an inability to fit harmoniously into the situation
at hand, not because of an intellectual deficiency, but because of the
disharmony between his various mental faculties. His extreme
sensitiveness and emotionalism, his vindictiveness, the total lack of
a sense of responsibility, his impulsive existence, all these, were
always at play in his relations with man. If to these be added his
extreme egotism and vanity, the reasons for his conflicts become
clear. "Here, the foreman thought he knew more than I did." "There, I
did not like the way they were running the business," etc. Among his
occupations, saloon-keeping and professional gambling played an
important role. He finally gave up all attempts at leading an honest
existence and turned to crime. Our record of the man in this regard is
rather incomplete, but according to his record at the Secret Service
Bureau, he was sentenced in 1890 to a two years' term for highway
robbery. In 1902 to three years for counterfeiting; in 1904 to three
and a-half, and in 1908 to six years for the same offense. These
sentences were incurred under various aliases. He married at a very
early age. He says he made up his mind one night to get married and
two days later was married. His conjugal life, like everything else he
engaged in, proved a failure and was characterized by repeated
desertions. He commenced using alcoholics at a very early age and has
indulged excessively all his lifetime. He has had several gonorrhoeal
infections, and has an active luetic infection at the present time.
On May 5, 1908, he was sentenced to a six years' term of
imprisonment. Soon after it became necessary to perform an operation
for appendicitis, and upon recovering he began to complain of having
been cut open and of having had poison put inside of him. The U. S.
Government sent men down to the prison who were threatening to kill
him. He saw detectives from Washington whom he recognized. He was very
apprehensive and refused to submit himself to an examination, and made
homicidal attacks upon the officers. On March 8, 1909, he was admitted
to this institution. His conduct here was characterized throughout his
entire stay by the same attributes of character which were at play
throughout his entire antisocial existence. He was at all times very
emotional. He was very sensitive, becoming offended on the least
provocation, and when laboring under some imaginary grievance his
antagonism and vindictiveness knew no bounds. He was constantly
plotting and scheming some means of inciting a revolt among the other
inmates and took every opportunity to put himself forth as the
champion of the other patients. He was very egotistical and vain and
showed a marked tendency to interpret most trivial occurrences in his
environment as having some reference to him. He was always ready to
endow every incident with a personal note of prejudice. He showed
throughout marked fluctuations of mood. One never knew what sort of a
reception one would meet. He was a pathological liar, was keenly alert
to everything that transpired about him and was always ready to
utilize every incident to his own advantage. He was depraved to a very
marked degree morally. He gave his past history without the least sign
of regret and when questioned concerning the reason of his criminal
life, he objected strenuously to being called a criminal, insisting
that what he did was right. At times he impressed one by his mode of
reaction to various daily occurrences as being as naive as a child
and suggestible to a very marked degree. He frequently threatened to
commit suicide if refused some of his impossible requests and showed a
marked tendency to hypochondriasis and exaggeration of actual ills. On
this basis he developed various persecutory ideas, exclusively against
those who had anything to do with his care and safe-keeping. The
warden at the jail before he came here tried to poison him and took
the opportunity of accomplishing this while he (the patient) was
undergoing an operation. The Government sent Secret Service men down
to watch him and persecute him. Here the physicians are doing the same
thing. They are trying to down him, to make his life miserable for
him, etc. Throughout his sojourn here he was clearly oriented, knew
everything that was going on and failed to show the least indication
of the existence of a deteriorating process. He showed also a marked
tendency to write a good deal of poetry and fiction in which he spoke
of himself as a martyr who had been persecuted and downed all his
lifetime. His stories were of a fantastic, adventurous kind, in which
gambling, shooting, and similar highly melodramatic situations were
enacted. On July 17, 1911, he was returned to prison as recovered.
Another point of interest in this case and one to which I have briefly
alluded before, was his tendency to the exaggeration of symptoms and
to malingering, but the malingering which he manifested was of the
kind that the child manifests in an endeavor to attract attention to
itself and to arouse the sympathy of those about him.

Here again we have before us a kaleidoscopic picture of the life of a human being who from childhood showed tendencies so antisocial, so criminalistic, that it is hard to get away from the belief that most of the attributes which went to make him just what he is, must have been inherited. Let us take this poorly-begotten organism and follow it through life. We shall see how its existence has been a continuous round of conflicts with everything it came in contact. He entered school and meets with the first obligation, with the first necessity for a well-regulated, purposive existence. What is the result? Truancy, disobedience, and finally expulsion--not because of intellectual deficiency, but because of those same attributes which later served to put him in the penitentiary. It was the first evidence of his pathologic emotionalism and vindictiveness. We next see him in an effort to lead an industrial life, but here, too, everything he does proves a failure, and likewise not because of intellectual deficiency, but because of a disharmony, a disproportion, between his various mental faculties. He could not, somehow, submit himself to any well-regulated existence. His egotism and absolute lack of the sense of responsibility made it impossible for him to adjust himself effectively to the world about him. He next tries matrimony, and the same story reasserts itself. His conjugal life is characterized by repeated desertions; and thus he becomes steadily more debased, more depraved, sinks to the level of the professional gambler and finally even this becomes too strenuous for him, and he turns to a life of crime. At the age of forty we find him with a record of numerous arrests, and as far as known, one-fourth of his lifetime has thus far been spent in jails and penitentiaries. The characterological anomalies at the bottom of his career came to the front already in his childhood days. Before completing his fourteenth year we find him deliberately planning the murder of a human being because of an insult. His idea concerning that situation has not changed in the least since then. He now speaks of it without the least sign of remorse or regret. As a matter of fact, he is inclined to impress one as being rather proud of that deed, and he cannot see the criminality of it. The atavistic nature of his act in throwing the dog into the oil tank is quite evident. Then his attempts at suicide throughout his lifetime, evidence of a pathologic emotionalism, must also be remembered. These are a few examples of his mode of reaction to everyday occurrences in life. Is it at all strange that he has developed finally into the habitual criminal? On the contrary, it would be rather strange that an individual with such attributes should turn out to be an honest, peaceful citizen. He likewise was a prey to all the vices of modern civilization, and these, as in the preceding case, unquestionably added to the dissolution of the originally defective organism. We finally meet with an illustration of the other phase of his mode of reaction. Following imprisonment on a charge of robbery, he develops a psychosis which necessitates his transfer to an insane asylum. Brief as the description of his psychosis has been, it is sufficient to illustrate that here we are likewise dealing with a psychogenetic disorder manifesting itself as a reactive expression of a degenerative constitution to an unpleasant situation. Shortly after his arrest he is being operated upon for appendicitis and upon recovery elaborates the idea that the warden of the jail, one of the members of that large class against whom he has been warring all his lifetime, takes this opportunity of placing poison in his body. He sees and hears people around his cell whom he recognizes as Secret Service men sent down from Washington to torture him. On his transfer to our Hospital he readily carries over his delusional ideas to the officials here. He is simply being persecuted by a bunch of anarchists, who are trying to down him and make life miserable for him.

It has long ago been questioned by psychiatrists whether these so-called delusional ideas of this class of patients deserve to be endowed with the value of delusions. Let us not forget that a similar attitude toward officialdom exists in the minds of criminals enjoying a respite from the law. It is the officers of the law, society's institution for the prevention and punishment of crime, that these people have to fear, and when they speak of being persecuted by those who have their care and safe-keeping in hand, it is not, necessarily, a pathological manifestation. The only difference between such paranoid ideas in the criminal at freedom and the one in confinement is that in the latter case, coupled with the stress of confinement, the stress of a forced routine existence, these ideas assume enormous proportions and in some instances become supported by fallacious sense perceptions. Their exaggerated self-consciousness, their great tendency to introspection, a tendency which is very much enhanced by confinement and plenty of leisure time for such indulgence, and their paranoid attitude toward law and its officers, makes it possible for them to endow the least significant occurrence in their environment with a personal note of prejudice. The least deviation from the normal routine has a meaning to them, a meaning which is readily interpreted as some evidence of persecution, of prejudice, etc. The course of their disorder shows so much evidence of this psychogenetic character that it is impossible to think that we are dealing with a psychosis which apparently has no relation to the situation at hand. Every symptom which they manifest can be traced to some definite cause and can be clearly explained as being of the nature of a reaction, of a motivated expression to a definite experience. It is, I believe, unnecessary to enter into a lengthy discussion to show that we are not dealing here with a case of dementia praecox, but with one of the degenerative psychoses and we will consider the criminal tendencies of this individual likewise as expressions of that same degenerative soil which permitted of the development of the psychosis. On July 17, 1911, the patient was returned to the penitentiary to serve out the remainder of his sentence.

CASE III.--P. F., alias H., white male, aged 42. Admitted to the
Government Hospital for the Insane, March 11, 1910.

Father is a chronic alcoholic; one brother a wanderer, has not been
heard from for twenty years; one sister a suicide; one sister left
home at the age of eighteen and has not been heard from since.

Patient was born in England in 1868. Was a healthy child as far as he
knows; no history of spasms or convulsions. Talked and walked at the
usual age. Of the diseases of childhood he had whooping cough, measles
and scarlet fever, from which he apparently made good recoveries.
Entered school at the age of seven; attended irregularly until he was
twelve years old. After leaving school he made an attempt at learning
a trade and worked as apprentice for some time. At fifteen he
endeavored to enlist in the British Navy, but was rejected on account
of palpitation of the heart. In 1884, at the age of sixteen, he joined
the Royal Marines; soon found this to be disagreeable to his tastes,
and wanting to secure his discharge, he stole a suit of clothes off a
dummy with the avowed purpose of being discharged for the offense.
Was arrested, plead guilty, and served a sentence of one month. In
1886, at the age of eighteen, he enlisted in the Royal Fusileers and
deserted therefrom about a month later. He then reenlisted in the
eighteenth Royal Irish Fusileers, shortly after deserted, and then
gave himself up; was court-martialed, dishonorably discharged, and
given a sentence of six months which he served in Brixton's Military
Prison, London. In 1887, at the age of nineteen, under the name of
Henry Sayers, he joined the Welsh Division of the Royal Artillery,
whence he deserted two months later and sold a kit and coat belonging
to another recruit; was apprehended, tried and given a sentence of six
months. In all, he was dishonorably discharged from the service seven
times. In 1892, at the age of twenty-four, he immigrated to this
country. On arriving here he worked about a month at railroading and
then enlisted in the Army, deserted after serving three months, and
crossed the Canadian Border. He subsequently returned and gave himself
up to a sheriff, was court-martialed, dishonorably discharged, and
given a sentence of one year and a half. After being released he
resumed his nomadic existence but in a more pronounced manner. Since
1895, he has had no definite occupation, subsisting on begging,
stealing, and peddling minor articles, chiefly on the two former. He
has spent most of his life since then in penitentiaries and
workhouses, and when at liberty, in cheap boarding-houses and
missions. As far as he can recall he has been arrested twenty-two
times for vagrancy since 1895, served four years at Moundsville and
Atlanta for robbery, and six months for theft. He commenced to indulge
in alcoholics at a very early age and has been an excessive drinker
all his life. Has been intoxicated on numerous occasions and has had
delirium tremens twice. In 1897 he indulged in opium smoking for
thirteen days and in 1904 sniffed cocaine for a similar period. On
three or four occasions in his life he has had sexual experiences
with men and there is a definite history of inversion. He has been
married twice. His conjugal life with his first wife was a very
unhappy one. He attributes this entirely to his own fault. There were
three children from this union, all of whom died in infancy. He left
his first wife without obtaining a divorce from her and subsequently,
in 1898, married again. This union was happier than the former one.
His second wife, however, died in 1905. There were no children from
this union. He acquired gonorrhoea and syphilis in 1899. In 1907 he
prepared an elaborate attempt at suicide, purchased a dagger for this
purpose, and set June 13th for the date. He was, however, arrested
shortly before this and thus his plan was frustrated. He stated that
it was not disgust of life that drove him to do this. He simply had a
desire to see whether he had the nerve to execute such an act. On
February 2, 1910, was arrested for vagrancy and begging, and given a
sentence of 180 days in the workhouse. While in his cell he attempted
suicide by inflicting superficial cuts over the praecordium, wrists and
calves of his legs with a piece of broken table knife. These were very
insignificant in nature. While confined in the workhouse he developed
various fallacious sense perceptions, saw visions of weird and
fantastic nature, and frequently these would take on a religious and
sexual coloring--he would see nuns' heads. He also developed auditory
hallucinations and would hear voices of a disagreeable nature. He was
subject to peculiar sensations as though there was a wire framework
inside him which made him squirm. This necessitated his transfer to
this institution.

On admission he was well-nourished, but prematurely gray. He had
numerous tattoo marks on his body; on the right forearm a woman in
tights and the head of another; on the left forearm initials U. S.,
flag, ship and cross; over the dorsum of left hand a star, and a band
across the wrist. His vision was impaired to some extent; otherwise
negative. Aside from a futile attempt at suicide which he made shortly
after admission, his conduct has been excellent. He has never been
known to become involved in altercations or quarrels with his fellow
patients and has obeyed fully the rules and regulations of the
Hospital. He was somewhat circumstantial during a lengthy
conversation, but in a superficial interview he made quite a natural
impression. He was clearly oriented and showed no memory defect. His
answers to the intelligence tests failed to show any intellectual
impairment. His emotional tone was unvaried. He was always very
polite, courteous and optimistic, and very popular with the
attendants. He willingly assisted with the ward work at all times, was
keen and alert, fully cognizant of everything that transpired about
him. He spent his time reading and rarely associated with his fellow
patients, whom he considered below him intellectually. He believed in
reincarnation, and thought himself to have been in a former being
Pharaoh of Egypt and the Earl of Warwick. He had tactile, auditory and
visual hallucinations of a religious and sexual coloring. These were,
however, transitory in type and perhaps better called
pseudo-hallucinations, as he was able to bring them on and cause their
disappearance at will. He was frank in his statements and discussed
the various ideas without hesitation. He was inclined to write a great
deal, especially poetry of the waste-basket variety, and considered
himself quite proficient in this respect. On February 2, 1911, he
appeared before the Staff conference where the advisability of
granting him parole of the grounds was considered. Upon being refused
this privilege he again attempted suicide by making several
superficial cuts across the wrists. These were quite insignificant in
nature. At the present writing the patient, I am told, if anything,
had improved somewhat. At any rate he shows no intellectual impairment
nor evidence of any progressive mental disorder. Patient was
eventually discharged on April 7, 1915, as unimproved and went to work
in a steel-plant in the District of Columbia. He soon, however,
reverted to his old alcoholic habits, came in conflict with the law
and was sentenced to the workhouse. While his strictly psychotic
symptoms subsided it is quite evident that the original defective
constitution which has been responsible for all of his past
difficulties has not improved.

Here is another individual who started out in life with a heavy
hereditary burden. His early childhood, as far as can be determined,
was normal. He entered school and here met the first obligation. He
wavered, showed a tendency, that early, to be unable to lead a
well-regulated life and in consequence his school attendance was
irregular. The next difficulty he met was in attempting to learn a
trade. He soon found this too strenuous and sought an environment less
exacting in nature, and at fifteen we see him endeavoring to enlist in
the Navy. This is probably the first indication of his "wanderlust."
He was rejected, and after another year's effort to get along in his
immediate environment, finally succeeded in entering the Navy. Soon,
however, he found out that Navy life was not what he had pictured it
to be. It, likewise, was too exacting. He had to live up to prescribed
rules, obey orders--things to which he could not reconcile himself,
and in consequence failed of a proper adjustment. He knew he could not
stand it, he must get out. He must seek something more suitable,
something less exacting. In looking for a way out of the situation he
availed himself of the first opportunity, stole a suit of clothes with
the avowed purpose of being discharged for the offense. Here is the
starting point of his criminal career. He did not reflect upon the
consequences. He knew he must gratify his desire to get out of the
Navy, must do it at any cost, and yielded to temptation. This yielding
to temptation, this lack of power of resistance, characterized his
entire life. He yielded to every vice that crossed his path; he stole,
he drank, he became a morphine habitue, he sniffed cocaine, acquired
gonorrhoea and syphilis in his promiscuous sexual trends, and lastly
yielded to sexual perversion. After having served his first sentence
he was released and again found himself thrown upon his own resources.
He had not, as yet, reached the stage of the habitual criminal with
the utter disregard for property rights, nor had he reached that
nonchalance of the hobo, whose philosophy rests upon the dogma that
the world owes him a living, that tomorrow will provide for itself
somehow. He began to yearn for the service again. There, at least, he
was provided with shelter and food. There, at least, he did not have
to worry for the tomorrow. He entered the Army, deserted, re-entered,
deserted again, and kept this up until he was dishonorably discharged
seven times. He could stand it just so long. His lack of stability,
his inability for any continuous purposive effort, made him slip from
under the stress. He has less dread for the future now. He was
beginning to acquire that naive philosophy that somehow the world
would provide for him. We next hear of him across the ocean. Here his
"wanderlust", his love of adventure, reasserts itself, but somehow he
did not fit into existing conditions, and unable, because of his
particular organization, because of his disequilibrated mentality, to
create for himself a suitable environment, his existence continued to
be an unbroken chain of conflicts, of contradictions, and of failure.
He finally tried matrimony, but here, too, he soon felt the
overwhelming burden of duties and obligations. He was not assisted in
sustaining these by any moral sense, by any paternal feelings--and
after a more or less continuous struggle to cope with the situation,
left wife, situation and all. He realized subjectively that he and his
wife were not congenial. As a matter of fact, his entire life has been
a continual round of uncongenialities, of inability for a proper
concourse with men and things in the world. Throughout his life his
ego occupied the center of the stage. It is he that has to be
satisfied first. After leaving his wife he resumed his nomadic
existence and sometime later married again. But by this time he was a
full recidivist, as well as an accomplished hobo. The nomad was no
longer able to adjust himself to a communal existence. Besides, it
required effort. He was expected to provide and he could not be
expected to do anything. Fate was in his favor--his wife died. It must
not be forgotten that by this time he had made full use of the kind
oversight of the law. He had been arrested innumerable times, he had
breathed the atmosphere of the workhouse and partaken of the
penitentiary menu. The once unfinished product had been shaped and
polished by the machinery of the law and order of our modern
civilization so that all dread and fear of punishment had lost its
value with him. At last the organism which was originally begotten
from decayed stock, which had been tossed and knocked about through
its entire existence, and preyed upon by all the vices that modern
civilization affords, began to falter and shake. He developed a
psychosis. I shall not enter here into an extensive discussion as to
the diagnosis of the disorder. The total absence of any indication of
progression in this man's mental disorder, the pliability of the
various delusional ideas and hallucinatory experiences, his perfect
control over them in the matter of bringing them on and causing their
disappearance at will, speaks sufficiently against dementia praecox.

CASE IV.--A. W., colored, aged 28. Mother suffers from neuralgia and
headaches; one sister died of pulmonary tuberculosis. One brother is
now serving a sentence at Moundsville Penitentiary for assault and
battery. Another brother has been frequently arrested for various
offenses.

Birth and childhood of patient apparently uneventful. During childhood
fell from a fence following which he was unconscious for some time.
Entered school between the ages of seven and eight, and attended
regularly for about two years, when he became unruly and
ungovernable--would play truant on frequent occasions, and finally
left school before finishing the fourth grade. He worked around home
for a little while, and was arrested the first time when eleven or
twelve years old, for assault. At fourteen he was again arrested for
some minor offense, and shortly afterwards was sentenced to one year
in jail. On August 20, 1902, at the age of eighteen was arrested for
carrying concealed weapons and discharging them in the street, for
which offense he served five months in jail. March 3, 1903, sentenced
to serve thirty days for larceny, and on the same date was further
charged with disorderly conduct, for which he was given fifteen days
in the workhouse. May 1, 1903, he was sentenced to sixty days in jail
for petty larceny; July 18, 1903, charged with fornication, but charge
was withdrawn. August 31, 1903, sentenced to thirty days in jail for
being drunk and disorderly, and committing assault. November 1, 1903,
sentenced to fifteen days in the workhouse on a charge of disorderly
conduct. November 17, 1903, sentenced to twelve years for assault and
highway robbery. He commenced using alcoholics at a very early age,
and has indulged heavily since then. He was admitted to the
Moundsville Penitentiary, December 13, 1903, where he remained until
July 4, 1908, when he was transferred to Leavenworth. His record at
the penitentiary is a very bad one, he was frequently punished for
various offenses and showed a constant tendency to disobey rules and
get into altercations with fellow prisoners. He was in solitary
confinement several times, and forfeited almost all of his good time.
Frequently became mildly excited, singing, shouting, praying and
cursing in the most irrational manner. This state of excitement
persisted unremittingly for seventy-two hours on one occasion. He
declared that his lungs were rotting with tuberculosis or some other
foul disease, and that he was suffocating. He persisted in exposing
himself in a nude condition and refused nourishment.

He was admitted to the Government Hospital for the Insane,
December 24, 1909.

Physical examination showed him to be a well-developed, healthy negro.
Both deep and superficial reflexes exaggerated; ankle clonus both
sides; hyperaesthesia of abdomen and face. He stated that two or three
months prior to his admission to this Hospital he became suspicious of
his food; had a burning in his stomach after eating; believed that his
health was failing him; his breath became short; voice weak and lungs
rotting. Early in December, 1909, he believed that he had been
chloroformed by the prison officials for five days; he was not certain
how this was done but believed that it might have been poured through
the keyhole. During this period he sang like a graphophone; voices
said "move his head", and his head would move itself. When his eyes
were open he saw nothing unusual but when they were shut he could hear
them operating a machine on his body; they were pumping his stomach,
and he became a skeleton. This was done to him through prejudice; did
not know who was prejudiced against him, but at the prison they know
all about it. Said he had not slept a wink since his admission to the
Hospital; his breath is short; he has pains around his heart, but
thinks he is getting better now.

He was a negro of limited mental capacity and possessed very little
acquired knowledge. He was clean and tidy in his habits, keenly
interested in his environment, and well oriented in all spheres. He
lacked insight into the nature of his trouble. Attention could be
easily gained and held; he comprehended well and readily, and showed
no memory defect. There was a very marked tendency to hypochondriasis
and exaggeration of actual ills. Soon after admission the active
symptoms of his disorder disappeared, and he gradually acquired an
adequate amount of insight, realizing that he had been insane. His
conduct, at first orderly, now assumed the same character as that at
prison. He frequently became involved in altercations with other
patients and on several occasions manifested decidedly vicious
tendencies. He was almost absolutely unamenable to the Hospital
regulations and on that account had to be frequently reprimanded. He
incited the other patients in his ward to all sorts of misdemeanors,
and when not having any complaints himself, would fight the other
patients' battles. He remained clearly oriented throughout. He was
decidedly deficient morally--could not see where his life had been an
unsocial one, and did not even promise to lead a better one in the
future.

Here, again, we see disease and crime rampant in the family history of
a man who himself began to manifest criminal tendencies at a very
early age. His school career is characterized by truancy, and he never
made an effort at an industrial career. At the age of eleven or
twelve, we already find him arrested for an offense against the
person, and before having reached his twentieth year he has received a
penitentiary sentence of twelve years. His psychosis is unquestionably
one belonging to that large group developing on a degenerative basis,
the same soil which is at the bottom of his criminal career. What his
future life is going to be may readily be surmised; he has not yet
reached his thirtieth year--and by turning him loose at the expiration
of his present sentence, society adds only another parasitic and
infective organism to gnaw at its roots. It would be indeed ridiculous
to expect the boy who at the age of nineteen was placed in the
environment of a penitentiary--the hot-bed of crime--to be turned out
a better man after having spent twelve years there. Something over two
years has elapsed since the original publication of this paper and I
am able to furnish some additional data concerning this case.

Upon the expiration of his sentence we were obliged to discharge the
patient because he showed no symptoms of mental disease, and in
consequence we had no authority for holding him in a hospital for the
insane. He was discharged in March, 1912. In October of the same year
he was again arrested, charged with assault with a dangerous weapon
and received a seven-year penitentiary sentence.

There can be very little doubt as to what his future career will be
following this second penitentiary sentence.

CASE V.--W. A., white male, aged 36 on admission to the Government
Hospital for the Insane, January 18, 1911. Father was an alcoholic;
mother neurotic, one sister insane, one uncle suicide. Mother enjoyed
good health during her pregnancy with the patient, but birth was an
extremely difficult one.

Patient learned to talk and walk at the age of five, when he was
severely scalded which necessitated his confinement to bed for a long
time. Entered school at the age of seven and attended for about eight
years, reaching the 6th grade. He experienced no difficulty in
learning but played truant on frequent occasions. His industrial
career constitutes an uninterrupted chain of failures. He was
frequently discharged for various offenses and quarrels with his
associates. He commenced to indulge in alcoholics at a very early age
and has been an excessive drinker all his life. Married in his
twentieth year and managed to live with his wife for six years, when
she left him on account of infidelity, non-support and drunkenness.
One miscarriage and one apparently healthy child were the results of
this union.

He came in conflict with the law for the first time at the age of
twelve or thirteen for some offense against the person. We have an
incomplete record of his criminal career, but this can easily be
surmised when we take into consideration that part of it which we do
possess. Between March, 1903, and December, 1910, he was arrested
thirteen times for assault, twenty-eight times for disorderly, and
drunk and disorderly, twice for housebreaking, once for petty larceny
and twice for vagrancy. Habitual drunkenness, destruction of private
property, and depredation on house furniture, add to the list of
charges against him. During this period he served a penitentiary
sentence, was tried for murder, and acquitted on a second trial on a
plea of self-defense, and on four different occasions, was ordered to
be examined mentally. Following a debauch, during which he was
arrested three times for assault, he developed a mental disorder in
jail while awaiting trial, which necessitated his transfer to the
Government Hospital for the Insane.

He developed the idea that someone was always around him looking for a
chance to kill him. Continually heard strange voices and noises. Was
very nervous and irritable.

The records accompanying him stated that for years he had had a
particularly bad and dangerous temper. That he had had several
previous attacks of mental disorder; had repeatedly committed
assaults, and was found not guilty of murder seven years ago--an act
of insanity. Had been arrested by the Washington police about
seventy-five times.

His mental disturbance soon cleared up, and on admission to the
hospital he was absolutely free from any psychotic manifestations.

He was a well-developed man of average intellectual attainments. He
was somewhat unstable emotionally, and his promises to lead a better
life in the future were usually accompanied by a good deal of crying.
He was a monumental liar, and although endeavoring to impress the
examiner with the idea of being quite remorseful about his past life,
it was clearly evident that his moral status was a very low one and
that his promises and resolutions were merely brought forth to aid him
in securing his freedom. He was extensively tattooed and showed
remains of an old syphilitic lesion.

Upon his release from the Government Hospital for the Insane, he was
given a year's sentence in the workhouse, and the Press has been
reporting frequent misdemeanors performed by him in the workhouse.

This case is interesting only in so far as it illustrates
exceptionally well the role of alcoholism in the habitual criminal. It
is, however, very difficult to decide whether the alcohol should be
considered here the cause of the man's degeneracy or its result. It
would appear that whatever injurious effect inebriety had upon this
man, and unquestionably it had, he owes his anomalies of character to
causes over which he had no control. We find that his father was a
chronic alcoholic, his mother a neurotic, a maternal aunt insane, and
an uncle a suicide. That these pathological traits in the antecedents
left their impressions on him cannot be doubted for one minute. He was
abnormal before environment and personal habits had had time to make
themselves felt. He, too, oscillated between penal institutions and
the Hospital for the Insane all his lifetime. That the same
degenerative basis lies at the bottom of both his moral and mental
alienation, cannot be doubted. Here, too, we are able at this date to
furnish other additional information. The patient was eventually
discharged from the Hospital for a similar reason as in the preceding
case, and in spite of all his promises and new resolutions was
readmitted to the Hospital on October 13, 1913 with an attack of
delirium tremens.

Let us endeavor to see now in what respects the above individuals simulate one another, and whether this similarity is of sufficient import to warrant the grouping of them into one category. Commencing with the family history we find disease and crime manifest in the antecedents, either direct or indirect, of all of them, that in all probability because of this, not one of these unfortunates was brought into the world with a sufficient impetus to carry him successfully to his goal. In every instance we find that the characterological anomaly became manifest already during their school career. It was the persistent truancy, disobedience and antagonism to submission to a well-regulated existence and not so much the incapacity to learn, which distinguished them from the other children in school. The same attributes of character which were at the bottom of their conflicts with the school authorities brought them into the hands of the police authorities soon afterwards. The contact with the outside world soon served to bring out other pathological traits of character. We now see them manifest a pathologic emotionalism, an unbounded egotism, a relentless vindictiveness and an apparently total disregard of consequences. Frictions with the surrounding world, which a normal individual meets in an ordinary manner with a view towards an efficient adaptation to existing conditions, were reacted to by them in a distinctly antisocial manner, with methods entirely void of consideration of the rights of others, an attribute so essential for a proper concourse with man. Thrown finally upon their own resources, when they had to rely for their existence upon some industrial pursuit, we find them lacking the most essential prerequisite for the efficient struggle for existence--definiteness of purpose, and continuity and persistence of effort. We find them leading a harum-scarum existence, drifting from place to place, and from occupation to occupation, never able to remain at any one undertaking for any length of time.

The next features which stand out prominently in the lives of these individuals are their recidivism and the fact that every one of them came under the observation of an alienist on one or more occasions in his life. What is at the bottom of all this? We cannot, of course, deny the very evident fact that these individuals differ from normal man and that this difference is due to their inferiority. But what characterizes this inferiority? Is it the lack of something which normal man possesses, or is it rather a disproportion, a disharmony between the various individual mental faculties of these individuals? In other words, is their inferiority a quantitative or qualitative one? Taking pure intelligence into consideration we find that they show no deficiency in this particular sphere. On the contrary, most or all of them show a degree of shrewdness and keenness which absolutely precludes the existence of an intelligence defect _per se_. Their recidivism is not due to an inability to distinguish between right and wrong. They know very well what is and what is not right, at any rate, as well as the average person, but they feel decidedly different from the average person about this distinction. They are what they are because of a discord, a disproportion between their various psychic attributes. The exaggerated egotism, which is so common to these individuals, serves to establish a pathologic degree of self-consciousness. This in turn makes them feel with an extraordinary keenness the everyday frictions in life, and now the pathologic emotionalism comes into play and being unsupported by any sense of altruism and morality they give way to their feelings in some criminal act. Their pathologic vindictiveness should also be mentioned. A sustained real or imaginary injury can never be forgotten by them.

These, in brief, I believe to be the characterological anomalies which distinguish the individuals herein reported from normal man and which at the same time are sufficiently common to all of them to justify their segregation into one distinct group of criminals.

I shall not enter here into a discussion of what part, if any, environment played in the shaping of the lives of these individuals, for several reasons, chief among which, however, is the fact that I have not had the opportunity of investigating thoroughly the environmental conditions in which they grew up and am therefore unable to evaluate properly this phase of the question. The fact, however, that my cases were culled from various sources and that the anomalous traits manifested by them were already present at an age when environment could hardly have had any lasting influence upon them, leads me to believe that it is heredity that is responsible for the major portion of this anomalous product. However, we shall leave this question to the decision of the practical eugenists. Personally I fully believe that we are dealing here with a type in which heredity plays an important role. I fully believe that these individuals were always the same as they are now and that the probabilities are that they will always remain so. Assuming then, for the moment, that we are correct, the question arises:--"Has society dealt with these individuals in a proper manner?"

This question must be answered decidedly in the negative. I will not enter here into an extensive discussion of a system of penology which might be specifically applicable to this class of individuals. I can only agree fully with the current opinions of eminent criminologists on this subject.

At the 1911 Congress of Criminology and Anthropology at Cologne, the following resolution among others was adopted:--"Hardened and professional criminals, recidivists, who present a great danger to society must be deprived of their liberty for as long a time as they are dangerous to the mass. Their liberty should be as a general rule, conditional."

Archibald Hopkins, Esq., has been recently quoted by Gault as follows:--"The Head of Scotland Yard, in London, said not long ago that nine-tenths of the serious crimes there were committed by men who had served one or more terms of imprisonment and who might be regarded as belonging permanently to the criminal class. His judgment was that if they could be eliminated from such a situation, violation of the law would be diminished to less than a third of what it has been. Why cannot this be done? Let the Courts be clothed with power, after two or more offenses, in its discretion, to pronounce a man incorrigible, who shall be sentenced for life, to whom no pardon shall issue. By an arrangement between the general government and the states, a colony could be established, say in the Island of Guam, where escape would be impossible, and where, under military guard, convicts could be made to earn their own living. Surely society has the right to protect itself from these incorrigibles, who are released only to prey on it again. They also are the class who rapidly produce their kind, and at present society puts no obstacle in the way.

"It is exactly as if, instead of forming colonies to which all lepers are compelled to go and remain, we permitted them, after a brief term in the hospital, to go where they please and to marry and produce more lepers. The incorrigible criminal is worse than the leper because he deliberately and purposely defies society and spreads his contagion. It can hardly be questioned that the permanent segregation of the professional criminal class would very greatly diminish crime, nor can it be questioned that society has the right to adopt such a measure of protection, nor that it would not be entirely practicable." (See Journal of American Institute of Criminal Law and Criminology, April, 1912, pp. 821 f.)

The only argument, and a very weighty one it is, which can be raised against the foregoing proposition, is whether the incorrigible criminal is sufficiently characterized by such unmistakable features as would enable us to recognize him when we see him, and thus justify his permanent isolation from the community. I believe he is, and the cases here reported are fair representatives of that class. Another problem which presents itself is: "Where shall we put the incorrigible criminal?" If we agree that he owes his criminality to causes over which he has no control and that the crime here is the outgrowth of a degenerative personality, a personality which is distinctly abnormal, it would seem that he belongs in a hospital rather than a penal institution, but is this unequivocally so? It is unquestionably true that these individuals are abnormal, that without actually being insane they evidence from their earliest childhood a more or less distinct deviation from the normal; they may therefore be considered as "border-line cases," _i.e._, cases which deviate from normal man and incline toward the insane through numerous gradations. As soon, however, as their abnormality manifests itself in distinct incorrigible antisocial tendencies, the right of society to protect itself from such an element must be considered. When free from actual psychotic manifestations (which very easily engraft themselves upon this degenerative soil) these individuals do not belong in a hospital for the insane. Here they serve only as a very troublesome and disturbing element, and wield an undesirable influence over many easily impressionable insane patients. They do not belong in a general penal institution because of the very deleterious influence they exert on the accidental but uncorrupted convict with whom they come in close contact in these institutions. It is my opinion that these individuals, forming as they do a distinct species of humanity, should be segregated into colonies especially designed for them, where under proper medical supervision, they should be made to earn their subsistence by means of some useful occupation. It is very obvious that an indeterminate sentence is the only rational way of approach to this problem and this should be supplemented by the vesting of the parole power in the hands of a board composed, not exclusively of members of the legal profession, but largely of physicians, and particularly those trained in psychopathology.

The foregoing cases, while distinctly abnormal mentally, owe their recidivism to a qualitative rather than a quantitative defect.

Since the original publication of this paper, I have had occasion to observe a number of recidivists in whom the defect was essentially a quantitative one, _i.e._, patients ranging in intelligence all the way from idiocy to moronism.

The following case is a good illustration of this type:--

R. W. (colored) was admitted to this Hospital for the first time from
the District of Columbia Reform School on February 8, 1898. He was at
that time serving a sentence for housebreaking. He was twenty years
of age at that time and examination showed him to possess the
intelligence of an imbecile. During his sojourn here he had several
maniacal outbreaks, but recovered from these and was discharged into
the care of his parents on November 23, 1898. Sometime in 1900 he was
again sent to the Reform School and was readmitted to this Hospital on
November 17, 1900. He suffered at this time from an acute
hallucinatory episode from which he soon recovered and was allowed to
go out on a visit on February 20, 1901. He never returned from this
visit but on July 23, 1902, was sentenced to twelve months
imprisonment for larceny. While serving this sentence he was admitted
to the State Hospital for the Insane at Norristown, Pennsylvania,
where he suffered from an acute maniacal attack with persecutory
delusions. He was discharged from that institution, by order of the
Court, on September 29, 1903. On January 1, 1904, he was arrested for
housebreaking and sentenced to three years imprisonment at the United
States Penitentiary at Moundsville, Virginia. From the above
institution he was admitted to this Hospital on May 8, 1905,
suffering from an acute maniacal attack. He soon recovered again and
was discharged on August 18, 1906, with a diagnosis of imbecility with
recurrent mania. He was readmitted here October 3, 1907, and
discharged April 1, 1909. On January 23, 1910, he was given a two
months workhouse sentence for petty larceny. On September 7, 1912, he
was again sentenced to four years in the Penitentiary for grand
larceny, from which institution he was readmitted here on January 19,
1915.

I shall not enter into a detailed discussion of this case. It is simply quite illustrative of the absolute necessity for permanent segregation of mental defectives.

When some of this clinical material was first published in 1912 it met with very gratifying recognition at the hands of those who were interested in criminalistics.

I wish to take this opportunity of expressing my particular appreciation of Dr. Healy's kind words of approbation and encouragement.

We all must agree that the first essential step towards a better understanding of criminal types consists in a thorough study of the criminal individual, such as is reflected, for instance, in the very excellent book by Healy on the "Individual Delinquent." Such studies have thus far, however, with but rare exceptions, not been made at the proper source,--that is, in the criminal laboratory, the penal institution.

The work which is being done with the juvenile offender is, of course, very important and very valuable; but in order that this work may be checked up scientifically it must be supplemented by thorough catamnestic studies of the juvenile offenders. This, I believe to be the only rational way of approach to the problem.

This will in time, I believe, furnish us data concerning the criminal which will enable us to evaluate in a correct manner the various traits and characteristics of the juvenile offender and thus enable us to render a correct prognosis in a given case. Once we shall reach a stage in the science of criminology when we shall dare to say of a juvenile offender, as we now unhesitatingly say of the leper, "Here is a human being who will always be a danger to his fellow-man and, therefore, should be permanently isolated from his fellow-man", the problem of recidivism will be solved.