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for the impairment mentioned above. Therefore, the customary high carbohydrate diet of institutions for feebleminded is to be regarded not as a matter of a chance or administrative economy, but as an automatically established way of meeting the metabolic peculiarity of the kind of patients cared for. Inflammation is always accompanied by increased disintegration of body cells which raises the demand for metabolic efficiency. Therefore, the administration of glucose in cases with retarded healing might be of therapeutic value because it induces an adequate handling of the products of cell disintegration. This conception has been checked up on two clinical cases with promising results.
The aim of this preliminary paper on this question is to call attention of the profession to the matter, ask for a constructive criticism of our conception, and obtain the necessary cooperation in checking it up on a large number of clinical cases. It is our opinion that a theory of this sort can be proven or disproven only after an adequate clinical check.
THE DEFECTIVE DELINQUENT AS A STATE PROBLEM
BY LEO J. PALMER, M. D.,
INSTITUTION FOR DEFECTIVE DELINQUENTS, NAPANOCH, N. Y.
The inference made in the title of this discussion is, that there is a more or less distinct type of individual of delinquent tendencies, who possesses characteristics peculiar to himself and who, because of his peculiarities, demands special attention from those who are responsible for the care of the State's social problems. This paper has for its purpose, the definition of the defective delinquent, and as well, his management in the light of what we now know about him. Who is the defective delinquent? He is that offending member of society, who upon examination, shows an appreciable limitation of responsibility, due to mental deficiency. In order that there shall be no misconception of the designation "mental deficiency" it may be well at this point to interject briefly that the term implies the lack of capacity in an individual to understand what is perceived by others; the lack of capacity to be able to act in such a manner as to achieve what one is striving for; and the lack of capacity to make correct combinations of new material, or in other words, logical power and phantasy-all of these functions being dependent on the number of possible associations. From the foregoing, it will at once be evident that the mentally deficient person faces impossibilities from the very beginning of his social existence. Intelligent achievement depends upon the proper selection of material to be associated -whereas irrelevant association is common to to the feebleminded, and because of his inability to associate freely and logically, he is handicapped. His concepts are insufficient, unclear, and have inaccurate limitations. He does not form complicated abstract ideas and frequently his abstract concepts are falsely construed. Differences in the intelligence levels of the feebleminded group, depend on the increase in the possible number of associations and their lesser or greater independence of emotional inhibitions. How then does the defective delinquent differ from the socially adjusted defective? The difference is comparable to poorly and well behaved children, and depends upon several factors, chief among which are personality, environment, supervision and constitution. The comparison, we believe, is analogous, for, after all, the feebleminded are the children of the race, and like children, they are more or less creatures of impulse.
Let us consider the characteristics of the defective delinquent as a group, and it will become evident that we are dealing with a
specific type, and at the same time, a problem of no little importance. In a recent study of over 500 cases in the New York State Institution for Defective Delinquents, analysis was made of the intelligence levels, personalities, delinquent habits, and delinquent tendencies. It was found that the median mental age was 9.19 years by the Terman revision of the Binet-Simon psychometric test. In this group there occurred the following distribution: Borderline cases, 23; morons, 366; imbeciles, 150; idiots, 1; total, 540. Further analysis of this group showed that the median performance capacity in years by the Pitner Patterson tests was 9.3 years. In the subsequent psychiatric study of the same group, it was shown that the group could quite readily be divided into three sub-groups. The first consisted of those with a mental age above 11.2 years, in which it was evident that the intelligence defect had ceased to be prominent, and that the predominating factor was that of personality and conduct disorder. In the second sub-group we found essential characteristics which were sufficiently constant to denote a definite type, which we have chosen to call the true defective delinquent, the upper limit of intelligence being 11.2 years, with the lower limit lying approximately between six and seven years. Below this latter limit was a group composed of palpably feebleminded persons, who might preferably be termed delinquent defectives, because of the predominance of mental defect as compared to delinquent tendencies.
Of this group of 540 cases, 62.6 per cent were classed as habitual offenders, having been arrested and placed on probation or committed to an institution at least three (3) times previously; 23.9 per cent were classed as occasional offenders; 12 per cent were first offenders, and 1 per cent were shown to be accidental offenders. The crimes for which this group were responsible were: Larceny, 30.7 per cent; burglary, 21.7 per cent; other crimes, 13.1 per cent; robbery, 9.8 per cent; assault, 7.6 per cent; homicide, 5.4 per cent; rape, 5.4 per cent; sodomy, 5.4 per cent. Note that 62.6 per cent of the offenses were of an acquisitive nature; 13 per cent were against person, and 10.8 per cent were of a sexual nature.
Efforts were then made to analyze the personalities of the individuals in the group, and although differences occurred, there was enough similarity in the make-up and reaction of the persons studied to denote a constancy of certain outstanding features, involving the conduct and emotionality. Eighty-five per cent
showed the characteristic reactions of the psychopathic personality. Abnormal behavior and temperamental disorders are found to have
been noted in the childhood of these individuals-exhibiting themselves in abnormal moods, stubbornness and irritability. The school period is characterized by similar reactions in a more accentuated form, and in addition there is noted lack of ambition, ready fatiguability of attention, rapidly changing interests, insubordination, frequent flight from the responsibilities of the school rooms by way of truancy. They become rebellious under supervision, are hypersusceptible to unfavorable suggestions, and readily turn to lying, thievery, and other compensatory activities, whereby they attempt to gain, by anti-social pursuits, the admiration of their companions which cannot be gained in the school room, because of their delimited capacities. Arrests for truancy and thievery are usual sequelae. The industrial history of the majority of the group is almost typical. Here again quick fatigability of attention, poorly sustained ambition and disregard of the future, with lack of planning ability, unite to promote general industrial restlessness and economic dependence. They are the industrial floaters, habitués of pool rooms, amusement parks, gymnasiums, etc., where they devote their time to the pursuits of pleasure and in disregard of their obligation to society. They are quick to react against organized efforts and appear to be deeply conditioned in a state of general dissatisfaction against the social order of things.
So much for the personality reactions in the community. In the institution they are unreliable, unstable emotionally, untruthful, selfish, lacking in honor with their fellow inmates, show no initiative, are lacking in sentiment, frequently boastful and in general are found lacking in the attributes which make up the constitution of the socially standardized personality.
In concluding a brief description of the general mental and personality make-up of the defective delinquent, we might summarize by saying that:
(1) The median mental age of the group is 9.1 years-with upper mental age limit of 11.2 years and lower limit between 6 and years.
(2) That 85 per cent of the group show definite symptoms of psychopathy.
(3) That at least 60 per cent are habitual offenders.
(4) Because of peculiarities of personality and subnormal intelligence, they are not susceptible to the usual reformative efforts of the regular correctional institution.
The question of prevalence of the feebleminded delinquent arises and may be answered by disclosing figures gathered here and there
during the past two years, which show that an average of 35 per cent of the inmates of our correctional institutions are definitely defective. This percentage may at first appear rather high, but when we consider that a large majority of inmates of the major correctional institutions have graduated from probation, juvenile correctional institutions, etc., into reformatory and prison, it becomes evident that either one of two things is at fault: The individual is incapable of profiting by experience, or the system is wrong. Frequently there is a combination of the two difficulties.
In New York State the average population of major correctional institutions is in round figures 7,000 inmates, and if our deductions are correct, upwards of 2,400 of these inmates are mentally abnormal. The New York State Institution for Defective Delinquents, with a rated capacity of 496, is now caring for 600 feebleminded offenders. What then of the balance of this group? Institutional executives are fast recognizing that their problem inmates are not simply "lazy"-"good for nothing"-"plainly troublesome" people, but that they are abnormal as compared with the average socalled normal inmate. Our own knowledge of the limitations of the defective delinquent, makes it obvious that training and discipline planned for and suitable to those of supposed normal mentality, is at once inadequate and improper for the reformation and restoration to society of an economically independent feebleminded individual.
It is unnecessary to discuss in detail the difficulties of administration in a population whose mental capacities range from normal to imbecile, but it is conceded that the more homogeneous the group the greater the success, and that any effort will be limited by the possibilities of the group being handled.
In view of the foregoing, it is apparent that the defective delinquent receives insufficient preparation, in the usual correctional institution, for his return to society, and that society would best be served, if he were segregated on an indefinite basis for specialized training and treatment. In an environment of this type, his personality difficulties may be studied and future efforts directed towards the prevention of a repetition of his previous maladaptations-next his abilities should be determined and efforts made to develop them to the fullest extent. We cannot hope to make skilled mechanics and artisans, but by taking into account his limitations, we are more apt to promote a better industrial adjustment. There then arises the question of discipline, and because of the erratic impulsive, in fact almost primitive nature, of the conduct of the defective delin