Studies in Forensic Psychiatry Part 16

1. The detection of malingering in a given case by no means excludes the presence of actual mental disease. The two phenomena are not only not mutually exclusive, but are frequently concomitant manifestations in the same individual.

2. Malingering is a form of mental reaction manifested for the purpose of evading a particularly stressful situation in life, and is resorted to chiefly, if not exclusively, by the mentally abnormal, such as psychopaths, hysterics, and the frankly insane.

3. Malingering and allied traits, viz., lying and deceit, are not always consciously motivated modes of behavior, but are not infrequently determined by motives operative in the subconscious mental life, and accordingly affect to a marked extent the individual's responsibility for such behavior.

4. The differentiation of the malingered symptoms from the genuine ones is, as a rule, extremely difficult, and great caution is to be exercised in p.r.o.nouncing a given individual a malingerer.

REFERENCES

[1] BRILL, A. A.: "Artificial Dreams and Lying," _Journal of Abnormal Psychology_, vol. ix, No. 5.

[2] DELBRuCK, ANTON: "Die Pathologische Luge," Enke, Stuttgart, 1891.

[3] FERRARI, L.: "Minorenni Delinquenti," Milano, 1895.

[4] PENTA, PASQUALE: "La Simulazione della Pazzia," Napoli, Francesco Perrella, 1905.

[5] WILMANNS: "Ueber Gefangnispsychosen," Halle, S. 1908.

[6] BONHOEFFER: "Degenerationspsychosen," Halle, S. 1907.

[7] KNECHT: Quoted by Penta.

[8] VINGTRINIER: "Des Alienes dans les Prisons," _Annales d'hygiene et de med.-legale_, 1852-53.

[9] JONES: Introduction to "Papers on Psycho-a.n.a.lysis."

[10] PELMAN: "Beitrag zur Lehre von der Simulation," Irrefreund, 1874, and _Arch. de Neurolog._, 1890.

[11] BIRNBAUM, K.: "Zur Frage der psychogenen Krankheitsformen,"

_Zeitsch. f. d. ges. Neur. u. Psych._, 1910.

[12] SIEMENS: "Zur Frage der Simulation von Seelenstorung," _Arch.

f. Psych. und Nerv._, xiv, 1883.

[13] MELBRUCH: Quoted by Penta.

[14] GLUECK, BERNARD: "Catamnestic Study of Juvenile Offender," _Journal of Am. Inst. Crim. Law and Crimin._, viii, No. 2.

CHAPTER V

THE a.n.a.lYSIS OF A CASE OF KLEPTOMANIA

_Introduction._--The past two years have been very profitable ones for the science of criminology, as they have brought to light two books on the subject which concretely reflect, on the one hand, the dying out of the old statistical method of studying the criminal, a method which will never tell the whole story, and on the other hand, the birth of a new kind of approach to the study of the criminal, namely--the characterological approach. The study of crime or antisocial human behavior from this newer standpoint at once becomes a study of character, and demands a scientific consideration of the motives and driving forces of human conduct, and since conduct is the resultant of mental life, mental factors at once become for us the most important phase of our study. Both of these books represent epoch-making culminations of years of hard labor and scientific devotion to criminology by two eminent students--Drs. Goring[1] and Healy.[2]

Dr. Goring's book, "The English Convict, a Statistical Study", appeared in 1913, and is the result of an intense statistical study of 4000 English male convicts, to which the author devoted about twelve years of his life. Dr. Healy's book, "The Individual Delinquent", which appeared in the early part of this year, reflects the results of thoroughgoing scientific studies of about 1000 repeated offenders, during the author's five years' experience as Director of the Juvenile Psychopathic Inst.i.tute in connection with the Juvenile Court of Chicago. Numerous reviews of these two books have appeared in medical and criminologic literature, and we shall only touch very minutely upon the difference in the methods of approach to the subject of these two authors as they concern the subject under consideration in this paper. I can do this no better than by quoting from a critical review of Goring's book by Dr.

White,[3] as it happily touches upon our very subject--namely, stealing.

"Take the more limited concept of 'thief', for example. One man may steal under the influence of the prodromal stage of paresis who has been previously of high moral character. Another man may steal under the excitement of a hypomanic attack; another may steal as the result of moral delinquency; another as the result of high grade mental defect; another under the influence of alcoholic intoxication, and so forth, and so on, and how by any possibility a grouping of these men together can give us any light upon the general concept of 'thief' is beyond my power to comprehend."

When one remembers that the 4000 units with which this really marvelous statistical machinery has worked for twelve long years had nothing more in common than the fact that they were English male convicts--the force of White's argument becomes quite apparent. I need not state that this view of Goring's work is not intended to detract one iota from the full measure of credit which this author deserves. His work will stand forever as one of the monumental accomplishments of the twentieth century.

Our views concerning Healy's contribution to the science of criminology will be reflected in the course of this chapter, which will indicate, I trust, in a way, his mode of approach to the problem, though he may not agree with me concerning the details of my interpretation of the case I am about to report.

_Definition._--Like many another I dislike the term "kleptomania" and would much prefer the term "pathological stealing" to denote the condition under consideration. Pathological stealing is not synonymous with excessive stealing as one would gather from the sensational use of the term in the lay press. Neither is Kraepelin's dictum that Kleptomania is a form of impulsive insanity, necessarily correct. It is obviously, however, a form of abnormally conditioned conduct. Healy's criterion of Pathological stealing is the fact that the misconduct is disproportionate to any discernible end in view. In spite of risk, the stealing is indulged in, as it were, for its own sake, and not because the objects in themselves are needed or intrinsically desired. This definition at once excludes all cases of stealing from cupidity, or from development of a habit. It furthermore excludes stealing arising from fetichism, p.r.o.nounced feeblemindedness and mental disease, such as is for instance ill.u.s.trated in the automatic stealing of the epileptic.

According to Healy, the vast majority of all instances of pathological stealing are those in which individuals, not determinably insane, give way to an abnormally conditioned impulse to steal.

_The Psychoa.n.a.lytic Study of Anti-Social Behavior._--In introducing the term "Psychoa.n.a.lysis" into this chapter I am fully conscious of the task I have set before me, of writing clearly and convincingly in a work of this nature on that vast and highly important subject which one at once links with this term. To strip it of its highly technical considerations, psychoa.n.a.lysis is primarily and essentially a study of motives, intended to bring about a better understanding of human conduct. We shall leave out from consideration the very intricate technique which this method of approach to the study of human behavior employs except to indicate the chief source upon which it relies for its information, namely, the individual's unconscious, that is, that part of the individual's personality which is outside of the realm of his moment-consciousness, and which is inaccessible either to himself or to the observer except through special methods of investigation. It would be highly desirable, indeed one would say almost imperative, to give a full discussion of the "unconscious" before a proper and sympathetic understanding of what is to follow can be made possible. This, however, is obviously out of the question in a limited chapter like this. Volumes have been written on the subject. I will only ask my readers to agree with me for the sake of gaining proper orientation with reference to the subject under discussion, in the conclusion which I quote from a masterly paper on the "unconscious" by White.[4] "We come thus to the important conclusion that mental life, the mind, is not equivalent and co-equal with consciousness. That, as a matter of fact, the motivating causes of conduct often lie outside of consciousness, and, as we shall see, that consciousness is not the greater but only the lesser expression of the psyche. Consciousness only includes that of which we are aware, while outside of this somewhat restricted region there lies a much wider area in which lie the deeper motives for conduct and which not only operate to control conduct, but also dictates what may and what may not become conscious." The foundation upon which the method evolved by the psychoa.n.a.lytic school rests has been aptly summed up by Healy, namely, that for the explanation of all human behavior tendencies we must seek the mental and environmental experiences of early life. One of the chief aids in gaining that knowledge we have in the study of the dream and symbolic life of the individual. The reasons given for our necessarily limited discussion of the unconscious, are likewise true of the dream and symbolism. Both of these subjects would require for a proper elucidation considerably more s.p.a.ce than this chapter affords.

Through the dream the unconscious betrays itself;--the dream represents the fulfillment of wishes and cravings which because of psychic and social censorship have become repressed into the unconscious. During sleep these barriers are in abeyance, and the unconscious psyche is given the opportunity for full play, albeit in a disguised and highly symbolic form. The proper interpretation of dreams presupposes a knowledge of the nature of symbolism in the life of man.

When we come now to a consideration of the facts brought to light through the psychoa.n.a.lytic study of man we are confronted with a still greater difficulty of presentation. There is so much that is of vital importance in this new psychology that we hardly know where to begin. As I am addressing those who are primarily interested for the moment in criminology, I may do well to begin with the subject of psychic determinism. In contrast to the common sentiment of all people in favor of free will in mental processes, the facts elicited by psychoa.n.a.lysis point to a strict determinism of every psychic process. Psychoa.n.a.lytic investigations have shown that in mental phenomena there is nothing little, nothing arbitrary, nothing accidental. In his book on the Psychopathology of Everyday Life, Freud[5] has thrown very convincing light on this subject. Certain apparently insignificant mistakes, such as forgetting, errors of speech, writing and action, etc., are regularly motivated and determined by motives unknown to consciousness. The reason that the motives for such unintentional acts are hidden in the unconscious and can only be revealed by psychoa.n.a.lysis is to be sought in the fact that these phenomena go back to motives of which consciousness will know nothing, hence were crowded into the unconscious, without, however, having been deprived of every possibility of expressing themselves. Thus we see that no mental phenomenon, and by the same token no part of human behavior, happens fortuitously, but has its specific motive, to a very large extent, in the unconscious.

The question may suggest itself here "why this extensive partic.i.p.ation of the unconscious in mental life", which brings us to a discussion of the principles of resistance and repression.

In speaking of the "unconscious" I purposely left out from consideration the way in which the sum total of its content was separated from the conscious mental life of the individual, in order to bring it in alignment with the discussion of the principles of resistance and repression. The content of the unconscious, broadly speaking, is brought about through the activity of these two principles. If one endeavors to unearth by means of psychoa.n.a.lysis the pathogenic unconscious mental impulses, or if one endeavors to bring to consciousness some instinctive biologic craving which may be responsible for the individual's conscious behavior, one regularly encounters a very strong resistance on the part of the patient, a force is regularly betrayed whose object it seems to be to prevent them from becoming conscious and to compel them to remain in the unconscious. This is Freud's conception of the principle of resistance and from its constant coming to the fore whenever an endeavor is made to penetrate into the unconscious, Freud deducts that the same forces which today oppose as resistance the becoming conscious of the unconscious purposely forgotten, must at one time have accomplished this forgetting and forced the offending pathogenic experience out of consciousness. This mechanism he terms repression. We spoke of an offending pathogenic experience, or in other words what has been termed a psychic trauma. But the same principle holds true of certain instincts which because of their peculiar nature become engaged in a kind of struggle for existence with the ethical, moral and esthetic attributes of the personality and are thrust out of the conscious mental structure as one might say by an act of the will.

We are especially concerned here with these inacceptable instincts, for the elucidation of which a brief review of Freud's theories on s.e.xual instinct is essential.

Thoroughgoing and painstaking dissection of the human soul, such as has been practiced by Freud for nearly a quarter of a century and by many followers of his theories in the past decade, revealed to him a number of unmistakable facts from the developmental history of the individual which forced him to postulate his very radical and revolutionary theories of the s.e.xual instinct in man. Recent behavior studies in the higher anthropoids have likewise revealed very interesting facts concerning the s.e.xual instinct of these animals. Freud was led to make certain a.s.sertions from his painfully acquired experience, such as the unfailing s.e.xual agency in the causation of neurotic manifestations, and that his experience of many years has as yet shown no exception to this rule, which quite naturally provoked a good deal of bitter and fanatic criticism not only from lay people but from experienced physicians. The cause for this lies in the nature of the thing itself, that much tabooed subject of s.e.xuality. Unfortunately, as. .h.i.tschmann[6] says, physicians in their personal relations to the s.e.xual life have not been given any preference over the rest of the children of men and many of them stand under the ban of that combination of prudery and l.u.s.t which governs the att.i.tude of most cultivated people in s.e.xual matters. Especially unsavory appears to most people Freud's theory of infantile s.e.xuality, a subject which has heretofore been looked upon chiefly from a moralistic standpoint, and was spoken of by others merely as odd or as a frightful example of precocious depravity. It is somewhat strange that of all the frightful depravities, if we wish to call it so--inherent in man, of the marked criminalistic components universally present in man which psychoa.n.a.lytic studies have revealed--the s.e.x depravity should have provoked the most fanatic attacks. Indeed to those who are accustomed to look at man with the psychoa.n.a.lytic eye, Rochefoucauld's incisive statement does not at all sound strange. He said, "I have never seen the soul of a bad man; but I had a glimpse at the soul of a good man; I was shocked." I therefore crave the indulgence of those of you who are not familiar with psychoa.n.a.lytic literature for what I am about to quote briefly from Freud's theories on the s.e.xual instinct in man.

Freud lays special stress upon infantile s.e.xuality as it is manifested in the suckling and in the child. The infant brings with it into the world the germ of s.e.xuality, which is, however, extremely difficult of comprehension since at this stage the s.e.xual feelings are not directed towards other persons but are gratified on the child's own body in a manner which Havelock Ellis has termed "autoerotic." This autoerotic gratification is gained through erogenous zones, that is, certain areas of the body which are peculiarly sensitized to s.e.xual excitations. Among these erogenous zones may be mentioned the mouth, lips, tongue, a.n.a.l region, the neck of the bladder as well as various skin areas and sense organs. Already in 1879, Lindner, a Hungarian pediatrist, devoted a penetrating study to the sucking or pleasure-sucking of the child. Freud emphasizes that the suckling enjoys s.e.xual pleasure, in the taking of nourishment, which it ever after seeks to procure by sucking independent of taking food. To many it may occasion surprise to learn that sucking is exhibited independently of its relation to the hunger instinct. It is, however, plain that the mouth is at first concerned only with the gratifying of the hunger instinct; later the desire for a repet.i.tion of pleasurable experience gained in this way is separated from the need of taking nourishment, thereby transforming this mucous surface into an erogenous zone. It is likewise difficult to conceive by the inexperienced in psychoa.n.a.lysis, that the child derives pleasurable sensations from the a.n.a.l zone. Because of the important role which a.n.a.l eroticism plays in our case we might speak more fully of this form of autoeroticism. One not infrequently observes in little children that they refuse to empty the bowels when they are placed on the closet because they obtain pleasure from defecation, when the retained stool by its acc.u.mulation excites strong irritation of the mucosa. The importance which scatological rites and ceremonials, that is, certain peculiar niceties practiced in connection with the emptying of the bowels, play in the evolution of the race have been extensively discussed in literature. Havelock Ellis[7] says in this connection--"The most usual erotic symbolisms in childhood are those of the scatologic group, the significance of which has often been emphasized by Freud and his school.

The channels of urination and defecation are so close to the s.e.xual centers that the intimate connection between the two groups is easily understood. There is undoubtedly a connection between nocturnal enuresis and s.e.xual activities, sometimes masturbation. Children not infrequently believe that the s.e.xual acts of their elders have some connection with urination and defecation, and the mystery with which the excretory acts are surrounded, helps to support this theory. Up to p.u.b.erty scatologic interests may be regarded as normal; at this age the child has still much in common with the primitive mind, which, as mythology and folklore show, attributes great importance to the excretory functions."

Many of these ceremonials one regularly discovers in the a.n.a.lyses of neurotics. We shall not dwell further here upon the erogenous zones activity in the suckling, but emphasizing again its importance along with the importance of autoeroticism in the s.e.xuality of the suckling will pa.s.s to the next phase of the psycho-s.e.xual evolution of man--the latent period.

The germs of s.e.xual excitement in the new-born develop for a time, then undergo a progressive suppression in a period of partial or complete s.e.xual latency. During this period, which is normally interrupted at about the third or fourth year, as result of organic evolutionary processes and the indispensable help of education, those mental forces are formed which appear later as inhibitions to the s.e.xual instinct and narrow its course like dams; mental forces such as disgust, the feeling of shame, the esthetic and moral standards of ideas. During this "latent period" a part of these s.e.xual energies is separated from the s.e.xual aim and applied to cultural and social ends, a process which Freud has designated by the name sublimation as important for culture, history and the individual.

Sublimation or the socialization of the s.e.xuality therefore is the transformation and utilization of certain components of the s.e.xual instinct for aims no longer s.e.xual in nature. At the end of the latency period the child's s.e.xuality reappears, frequently but not necessarily induced prematurely by seduction. In addition to the autoerotic gratifications spoken of above, the child is now capable of the choice of a love-object accompanied by erotic feelings. Because of the dependency of the child this first choice of a love-object is directed towards parents and nurses either of his own or of the opposite s.e.x.

"Incest complex"--Now too the child under the influence of occasional seduction may become polymorphous-perverse, that is, may become subject to any form of s.e.xual perversion. He likewise shows a preference in the selection of his love-object for his own s.e.x, h.o.m.o-s.e.xuality.

At p.u.b.erty two significant changes take place in the psycho-s.e.xuality of the individual. First the primacy of the genital zone a.s.serts itself, and second, the heretofore autoerotic character of the s.e.xual activity is lost and the instinct finds its object. In order that the former change may be successfully brought about, there is necessitated an amalgamation of all instinctive tendencies which proceed from the erogenous zones and a subordination of all the erogenous zones to the primacy of the genital zone. All this is facilitated by the development of the genital organs and the elaboration of the seminal secretion. To these conditions there is also added at p.u.b.erty that "pleasure of gratification" of s.e.xuality which ends the normal s.e.xual act, the end pleasure. The second function, the choice of a love-object, is influenced by the infantile inclination of the child towards its parents and nurses which is revived at p.u.b.erty and similarly directed by the incest barriers against these persons which have been erected in the meantime. If on account of pathological heredity and accidental experiences, this amalgamation of the excitations springing from various sources and its application to the s.e.xual object does not occur, then there result the pathological deviations of the s.e.xual instinct, determined in part by earlier processes, such as a preservation of a definite part of the original polymorphous-perverse tendency. The perversions are thus developed from seeds which are present in the undifferentiated tendencies of the child and const.i.tute in adults a condition of arrested development.

Thus we see that the s.e.xual impulse does not suddenly emerge as a new phenomenon at the age of p.u.b.erty, but that the form a.s.sumed at this period is gradually evolved from rudimentary elements present even in the earliest years of life. s.e.xuality is not absent in the child, it is merely different, being unorganized and imperfectly adapted to its later functions. All this primordial ma.s.s of pleasurable activities enumerated above, undergoes profound modifications as the result of growth and education. One part only becomes selected and differentiated so as to form the adult s.e.xual impulse in the narrower sense. A greater part is found to be incompatible with social observance, and is repressed, buried, forgotten. The repressed impulses, however, do not die; it is much harder to kill old desires than is sometimes thought, they continue throughout life to strive toward gratification. This they cannot do directly, and are thus driven to find indirect, symbolic modes of expression. The energy is transformed into these secondary, more permissible forms of activity, and furnishes a great part of the strivings of mankind that lead to social and cultural interests and development in general--sublimation. (Jones.)

I don't know whether I have succeeded in putting clearly enough the Freudian views of s.e.xuality, limited as I have to be in my expositions of his theories. I do wish, however, to leave the impression which one must gain from two sentiments frequently expressed by various authors, namely, "Man s.e.xualizes the universe," and "Man is what his s.e.x is."

_s.e.xuality and Criminality._--A method of psychological a.n.a.lysis which aside from its originally restricted field has already thrown so much light upon various cultural aspects of life, such as art, poetry, religion, folklore, and mythology, cannot fail to furnish some very helpful discoveries for the problem of criminology. As far as pathological stealing is concerned a number of very suggestive studies have already appeared, a review of which Albrecht has prepared for the Journal of the American Inst.i.tute of Criminal Law and Criminology. The fact that rich, or at least well-to-do, women are sometimes guilty of theft in the big Department stores has always received a certain amount of attention. Studies of this phenomenon have been made by Duboisson, Contemps, Lasegue and Letulle. In each case examined the woman declared that some unknown power had suddenly compelled her to touch some object, and put it in her pocket.

Stekel,[8] a Viennese psychotherapeutist, claims to have repeatedly proved to himself by psychoa.n.a.lysis that the root of all these cases of kleptomania is ungratified s.e.xual instinct. These women fight against temptation. They are engaged in a constant struggle with their desires.

They would like to do what is forbidden, touch something that doesn't belong to them. We cannot give here the a.n.a.lyses reported in the literature, though I a.s.sure you that they carry convincing proof of the tremendous role s.e.xuality plays directly or indirectly in the causation of pathological stealing. This is not confined only to thieving connected with fetichism, numerous cases of which have been reported in the literature. But even less radical Freudians than Stekel admit the importance of s.e.xuality in pathological stealing. Thus Healy, who is eminently fit to speak authoritatively on the subject of recidivism, and who is unusually conservative in his statements, has the following to say:--

"The interpretation of the causes of this impulse to steal is of great interest. We have shown in our chapter on mental conflicts how it may be a sort of relief phenomenon for repressed elements in mental life. The repression is found often to center about s.e.x affairs." Again, "The correlation of the stealing impulse to the menstrual or premenstrual period in woman, leads us to much the same conclusion. Gudden, who seems to have made the most careful studies of the connection between the two phenomena, maintains that practically all cases of shoplifters whom he has examined were, at the time of their offense, in or near their period of menstruation." Healy does not go beyond this. He is as yet not ready to agree that some s.e.x difficulty is the only conflict back of kleptomania.