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quent, this is no small problem. Routine that is suitable for the inmate of nearly normal intelligence, forethought and judgment, is quite unsuitable for one who is unreliable, selfish, unthinking, and emotionally unstable. Only by careful study of the individual can he be properly placed within the institution and trained in social responsibility.
How can we know whether our inmate is profiting by his training and how shall we know when he is socially fit to leave the atmosphere of controlled environment? Observation and prognosis can only be based on the results of psychiatric study, for we are dealing with a definite mental problem involving the intellectual status of the defective, and as well, his personality and behavior. Our observations will determine the course to be followed in the individual case, and should the results be unfavorable, fortunately for society, another one of its enemies is not turned loose simply because a date has been turned upon the calendar.
There is no need to delay further in arriving at a conclusion. It is clearly established that the defective delinquent presents not only subnormality of intelligence, but that he suffers from personality disorder, and shows anti-social conduct deviations-that he occurs in the proportion of at least 35 in every 100 inmates of our correctional institutions, and that because he is abnormal he is not susceptible to training intended for the normal.
The solution obviously must be found in the following lines of action: (1) By increasing the facilities for personality study of the entire criminal or delinquent group so that the defective delinquents may be properly segregated. (2) By making provisions for their proper detention over an indefinite period (for no one can foresee how long or how short a period of training will be required). (3) By increasing the State's facilities for handling this large group, keeping in mind that the borderline cases may succeed in regular correctional institutional environment, and that those individuals with mental ages below 6 years would be best cared for in the usual institution for the feebleminded.
Fortunately New York State has led the world in progressive criminology in the establishment of the Institution for Defective Delinquents, and this with the establishment of the new psychiatric classification clinic at Sing Sing, would indicate that our State bids fair to continue along progressive lines and place criminology and penology on a firmly scientific and practical basis.
INADEQUATE CHILDHOOD TRAINING, A FACTOR IN
BY CLARENCE H. BELLINGER, M. D.,
FIRST ASSISTANT PHYSICIAN, UTICA STATE HOSPITAL
Much time and energy have been devoted to the study of the socially unfit in an endeavor to determine the factors which cause individuals to conduct themselves in such a manner that they become objectionable to society as a whole. We have learned the etiology of a majority of the organic psychoses, and know the causes we are able to warn the public against those agencies, especially alcohol and syphilis, which bring about organic changes in the nervous system with resulting impairment of the mental faculties. When we turn to the so-called functional group, which comprises more than 50 per cent of the cases of mental illness, and into which category we might classify many of the socially unfit commonly termed criminals, we are in many of the cases, unable to postulate the underlying etiological factors. This group has been the subject of persistent and untiring study and investigation in an effort to establish a definite etiology for the various types composing it.
The relation of heredity to functional psychoses has been the subject of thorough investigation and the conclusions drawn by a majority of the more competent observers indicates that outside of the realm of mental defect heredity plays little or no part in mental development excepting as it influences the environment of the child.
A small number of observers are inclined to attribute many of the cases regularly placed in the functional group to focal infections, but a considerable number of these patients after the most careful examination show no foci of infection. In those cases in which infection is found and removed, there often is no appreciable improvement in the mental condition. While there can be no question but that we should be ever alert to the possibility of the presence of foci of infection, and should take every means to bring about their removal and to place those who are mentally ill in the best physical condition; nevertheless, we cannot look upon the theory of focal infections as solving the question of the etiology of the functional nervous disorders.
Much work has been done on the endocrines in an attempt to
establish some relationship between endocrine disturbance and the various forms of mental disease. While many interesting facts have been noted, we are as yet unable to say definitely that endocrine disorder is an etiological factor in that group of mental diseases generally considered as inorganic. Investigation of the endocrines should be continued in the hope that something of material value will eventually be found.
During recent years we have come to associate individuals showing anti-social conduct without evidence of organic nervous disease with fairly well defined types of personality. A majority of observers have come to believe that the anti-social reactions of many have their roots in the personality make-up of the individuals which prevents them from adjusting themselves to and complying with the laws and customs of their fellowmen. Psychoanalysis has thrown much light upon the influence of make-up on the symptom picture in both organic and functional mental disturbances. As a result of our studies of personality we have been able to formulate certain well defined types, such as the psychopathic, schizoid and syntoid.
Having arrived at the conclusion that the non-organic mental disorder are secondary to defects of personality; the question then arises, what is the cause of the personality defect? During the past two years the writer has been making a special effort to secure accurate and complete anamneses in all cases not developing upon an organic basis. The histories included a study of the personality make-up of the members of the immediate family, the home situations, general childhood training and personality of the patients. From a careful study of these histories it has been possible to note the manner in which the various factors in the family situation tended to mold the personality of the individuals so that they were eventually unable to comply with the demands which society made upon them; also to establish a relationship between the personality make-up of the various patients and the symptom pictures which they presented. A review of 100 cases of dementia præcox, having satisfactory histories, showed that 94 patients had a make-up that was decidedly schizoid, 5 showed relatively more schizoid tendencies than syntoid, and it was in only one instance, an advanced case of dementia præcox with deterioration, in which the personality make-up was essentially syntoid. A study of the
personality make-up of 30 cases of manic-depressive showed that they differed vastly from the personality make-up of the dementia præcox group; 22 of the 30 cases were described as being subject to emotional variations, while 8 were noted as showing no striking personality traits. This whole group was essentially of the extroverted type, and in every instance the syntoid traits outweighed the schizoid features.
The writer has been interested in the development of the psychopathic personality, and while the number admitted to State hospitals suffering from psychosis with psychopathic personality is relatively small, an opportunity has been offered to observe a considerable number of individuals suffering from a psychopathic personality in the mental hygiene clinics, and also in the examination of individuals charged with delinquency and crime. In practically every case (care being taken to exclude those showing actual mental defect) the pathological personality which the individual manifested seemed to be the direct result of faulty childhood training, which in the majority of cases began at an early age. In fully 90 per cent of these psychopathic individuals there was definite early sex trauma and subsequent early sex perversions.
In discussing the influence of early environnment the question is frequently asked, why does only one in a family of three or four children develop undesirable personality traits and the remainder of the children escape? A careful study of the family situation in cases of this kind will show that the child developing the undesirable personality traits was by virtue of age, sex, intelligence, personal appearance, ill health or economic conditions subjected to much different attention and training than the other children of the same family. In many instances the attitude of one or both of the parents toward the child differed materially from that accorded to the other children. Parents as a rule are unconscious of this, but sometimes they will admit it. However, to the disinterested observer these facts are plainly evident. The Oedipus and Electra complexes when present were invariably found to be associated with faulty training of the child in the home. Some of the more common forces which were found to contribute to the formation of these complexes were the absence, disability or death of the parent of the same sex, in which event the individual child assumed to a certain extent the role of the incapacitated or absent parent. A stern
exacting attitude toward the child by the parent of the same sex, with a sympathic attitude by the parent of the opposite sex was found to contribute to parental fixation in many instances. In two cases observed during the past year the individuals were subjected to the discipline of strict and exacting parents, the result being in both instances that the individuals left home at an early age, wandered about the country for years, indulged in many vices and sex perversions and eventually became criminals.
The following cases would seem to demonstrate the manner in which the family situation and faulty childhood training of the individuals so molded their personality that they were unable to adapt themselves to the demands of society.
V. D., male, 20 years of age, single, carpenter, personality make-up showing predominence of schizoid traits. Family history complete for three generations, negative except for father who was an uneducated man, leg amputated (when patient was five years of age), excessively alcoholic, irritable, dishonest, unkind and abusive to family. Mother kind, agreeable, hard worker, interested in family, devoted to church, many friends.
The patient was an only son, the second child of a family of seven. Early life and childhood uneventful. Began school at seven, left at 14, at which time he was in the seventh grade.
As a boy he played naturally with other children until 10 years of age, following which he remained at home when not in school in order that he might assist his mother, who did laundry work. As a result of the family situation he never had an opportunity to mingle socially with companions and lost contact with the friends whom he had made in his early childhood. Three days before his admission to the hospital, at the age of 20, he became excited, said he was going to take a trip around the world with his mother; that he did not have to work longer as all the money in the banks belonged to him. On the day prior to his admission he walked into a bank and demanded that all the money be turned over to him, which act led to his arrest and subsequent commitment.
Physical examination at the hospital showed him to be of the asthenic type, male distribution of hair, in good physical health.
His manner was exalted. He carried his shoulders erect, was dominant toward the other patients, proclaimed himself to be the ruler of the universe, refused to do any work, whistled, sang and at times showed considerable irritability. His conversation was at times somewhat disconnected. In giving an account of his life he said that as a small boy he sold papers and earned all the money he could, giving the same to his mother who used it in the care of the family. At the age of 14 he left school, following which he