Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

There are a number of other "phobias," and the patient's fears are manifested at the most peculiar objects. Agoraphobia, for instance, is the fear of crossing an open place. These patients begin to tremble as soon as they get away from the line of buildings in a street, in their way across the square. This trembling becomes actual staggering, with a sense of oppression over the heart that makes locomotion almost or quite impossible. Claustrophobia, the opposite of Agoraphobia, is the fear of narrow places, and prevents some people from going through a narrow street with high buildings. Many of these "phobias" have a physical basis in some organic or nervous heart affection.

The Tramp.—One of the striking manifestations of paranoia in our modern life is the tramp. Most people are inclined to consider that the cause for the wandering life of these unfortunates is rather what a distinguished physician euphemistically called by the scientific name, pigritia indurata, that is, chronic laziness, than any pathological condition of mind. Most tramps, however, will be found, on that close acquaintanceship which alone will justify judgment of their actions, to have many other peculiarities of mind besides the shiftlessness which prompts them to wander more or less aimlessly from place to place. After all, it will hardly be denied that the calm [{297}] acceptance of the notion that it is more satisfactory to indulge in laziness and wander without home or fireside, suffering the many privations and hardships, especially from the weather which these creatures do, rather than work and be respected and comfortable among their fellows, is of itself irrational.

Many of these tramps prove on close acquaintance to be interesting pathological characters. Various stages of outspoken paranoia will be found to exist among them. It is not unusual to find that certain among them have acquired the idea not so uncommon now among large classes of humanity, that the world is so unjust in its treatment of the labouring man, that work seems to them almost a persecution that must be undergone for the sake of the pittance derived from it. Sometimes there is the actual extrinsic idea of personal persecution for some fancied wrong done to a large corporation during a strike, or labour troubles, which they cherish as the reason for which they have had to give up a fixed habitation, and resign the idea of supporting themselves honestly and respectably. This persecution stage of paranoia easily turns to the second phase of this affection as already described, that in which the fancied victim of persecution becomes in turn the persecutor. Tramps thus readily give way to even organised attempts at revenge upon social order, and are led to believe themselves justified in attempts to burn and otherwise destroy property because of their enmity towards property holders and employers generally. Not infrequently the third stage of paranoia, in which there are delusions of grandeur, may be observed.

Personally I have known two tramps who wandered about the country with these grandiose ideas. One of them thought that he had in his possession immense wealth in the shape of large checks, signed supposedly by various important capitalists, and even foreign rulers. These checks were actually signed in the names of these personages, at the tramp's own request, by any chance passer-by or acquaintance. This patient died in a country insane asylum in the demented stage of paranoia, having gone through all the usual phases of the disease. Another tramp was confident that each recurring election he was to be elected to one of the highest offices in [{298}] the state, or even to be made President of the United States. Not every one was taken into his confidence in this matter, however. The simplest declaration after the election from any chance acquaintance would assure him of his success at the polls, and on more than one occasion he turned up at the Capitol to claim exalted office, but was generally inoffensive in his ways, and was rather readily persuaded that his term of office did not begin for some time. It is easy to understand that a person might come into the possession of the idea that the official holding office in his stead should be removed; the result might very well be one of the sad tragedies supposedly due to anarchism, but really to paranoia.

Of course as with criminals, so with tramps; not a few of them take up this manner of life without any sufficient justification in their mental state to lessen our worst opinion of them. I do not think I should hesitate to say, however, that the majority of these unfortunates present distinct signs of physical and mental degeneration and are rather deserving of pity and care than of condemnation. They need, as a rule, very special environment to enable them to lead ordinary, respectable lives, because they were not originally endowed with sufficient initiative and independence of spirit to enable them to carry on the struggle for life in the midst of the hurry and bustle of our modern civilisation. As the pressure of the time becomes severer, more of these unfit come into evidence. They arc examples of the lowered mental states, unable to stand the rivalry with fellowmen, and ready to give up the struggle whenever the example of others who have already given it up is brought prominently to their notice.

It is not a little surprising how many of these tramps belonged originally to excellent, respectable families. Careful investigation of their personal history, however, will show that they have been, as a rule, backward children at school, always a little awkward in the way they took hold of things early in life, unsuccessful in the rivalries of school competitions, and in their first efforts at labour after school days were over. They always needed the encouragement of those whom they loved and respected, to keep them at their unsatisfactorily fulfilled tasks. They were the predestined failures [{299}] in life, and have found out their uselessness early in their careers. This is the view of tramp life that is coming to be realised as true by all those who have studied the question, not from the standpoint of theory, but of practical experience with it.

So-called Monomania. The old term for paranoia employed for a long time was monomania, a word coined by Esquirol at the beginning of the nineteenth century. This word has dropped out of the terminology of mental diseases because there is no such thing as a patient suffering from a single symptom of mental disturbance, that is, being mentally perturbed on but one line of thought. There are always others, though they may be hidden except from the careful investigator. When Esquirol introduced the term he applied it to the most prominent symptom of the patient's mental alienation, but did not intend it to be taken as excluding other symptoms by which the essential nature of the patient's insanity could be diagnosed. Careful study will always disclose the fact that other symptoms are present. The word monomania has been an unfortunate one for scientific psychiatry, because it has been abused to shield criminals. The plea is often heard that a person under charge of crime is really subject to some mania that brought about the commission of the crime.

We often hear of kleptomania as a defence for persons who have failed to recognise the distinction between meum and tuum, and are haled before the court because of the detection of infringements of this distinction. True kleptomaniacs there are, but there are always other symptoms of their mental disturbance besides the tendency to steal. Their queerness in other ways has usually been recognised by their friends and by their family physician before the incident which calls attention to this special form of disequilibration occurs. Kleptomaniacs, too, are usually prone to take things of little value, or not especially suited to their wants and for which they have practically no use.

It is true collectors, that is, those who have a hobby for gathering curiosities of one kind or another to make a collection, may become so interested in additions to their collection [{300}] as to be tempted to appropriate to themselves articles of which they can not otherwise obtain possession. Such actions may easily go beyond the bounds of reason. It must be remembered however, that the collection mania itself is often so pronounced as to be a little beyond the bounds of ordinary rationality.

Other so-called monomaniacs have the same characteristic and are associated with related symptoms of mental disturbance. Pyromania is sometimes pleaded as a defense for arson. It is a legitimate defense, however, only when the careful tracing of the patient's history beforehand shows the existence of other symptoms of mental unbalance. The homicidal mania is of the same order. There have been cases where men seem to have delighted in inflicting injuries or death upon fellow creatures from pure malice. Such cases as that of Jack the Ripper, for instance, are undoubtedly due to a special tendency to take life. In these cases, however, associated symptoms are never lacking. It is not improbable that in Jack the Ripper's case a sexual element was present, because the victims were always of one low class, and that the general character of the murderer would have revealed his irresponsibility. There are several stories of children—whose mothers delighted in seeing their husbands, who were butchers, slaughter animals—who seem to have had a veritable mania for seeing blood flow and to have exercised it in the murder of human beings.