Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

Only the most careful examinations of the previous life of the patient, the investigation of childish tendencies and habits at school, and the incidents of boyhood and youth will sometimes enable the expert to recognise the constant existence of symptoms of mental disequilibration, the decided manifestation of which leads to serious events in after life. Monomania as a defense for crime has brought expert evidence into great disrepute. In this matter the greatest care is undoubtedly needed, however, for it is easy to do great wrong and punish the irresponsible victim of an impulse over which he has no proper control. On the other hand, it must not be forgotten that no such thing is known to exist as the perversion of the will on a single point. Moral insanity with regard to one special set of actions is a delusion that the [{301}] increase of knowledge with regard to mental diseases has erased from the text books on this subject.

Responsibility of Paranoiacs.—From what has been said it is easy to understand how difficult is the determination of the responsibility of paranoiacs. Many classes of persons ordinarily considered to be quite responsible for their actions are yet so circumstanced that they are led into the performance of actions usually not considered rational, though not tempted thereto by any benefit directly accruing to themselves. On the contrary, it not infrequently happens that the mode of life adopted by the paranoiacs is of such a kind as would of itself, because of the hardships involved or the mental trials, deter ordinary people from following it. Paranoia, at least in its severer forms, completely justifies the plea of irresponsibility for actions committed. When it is remembered, however, that paranoiacs are often cunning enough to take advantage of their own supposed queerness voluntarily to commit crimes they might otherwise be deterred from by fear of punishment, some idea of the difficulty of the decision in these cases may be appreciated.

It is important, of course, that the physician should, as far as possible, avoid falling into the error of judging such people too harshly, since after all on him depends the attitude of society towards them. It would seem to be quite as important that the clergyman should occupy an advanced position in this matter. It might seem that charity could easily be overdone; it must never be forgotten, however, that it is better that ninety-nine guilty should escape rather than that one innocent person should be punished.

As a matter of fact, prejudice is much more likely to be against the supposed criminal than in his favour. While it is often declared that too many persons, who have done at least material wrong, are allowed to escape deserved punishment, as our knowledge of mental diseases increases there is more and more of a tendency on the part of experts to recognise that for many apparently voluntary actions men have only a modicum of responsibility. Responsibility is, after all, not the same in all men, but modified very much by the character of the individual, by his environment and by the [{302}] motives which have come to be the well-springs of his actions. No two men are equal in their responsibility when there is question of certain temptations to do wrong. Some men find it perfectly easy to resist allurements to dishonesty which others can not resist. Some men are perfectly free as regards their attitude towards indulgence in spirituous liquors. Others find it almost impossible to resist their cravings in this direction. One might go through the list of passionate actions and find this true with regard to every one of them. If this must be admitted with regard to men who are considered perfectly sane and responsible, how much more so does it become true of those who are already somewhat mentally unbalanced?

Unfortunately, the tendency to judge harshly, rather than mercifully, still continues to be one main reason for the infliction of punishment where often it is not deserved. Above all the clergyman must be a leader in this tendency to mercy, and his influence should be felt in popular education in this regard. It only too often happens that clergymen are found to be strenuous upholders of the opinion that right is simply right and wrong, wrong, and that a man who knows the difference between right and wrong must be considered as responsible for his actions, no matter what modifying circumstances or mental conditions may enter into the problem of the decision as to his responsibility. If the clergyman would but realise how difficult in any individual case must be such a decision, and how much must be known with regard to the previous character of the individual, then a great beginning for the modification of the present over-severe modes of thought will have been made.

From a theoretic standpoint, it would not be easy to state all that the physician considers necessary to enable him to make his decision as to individual responsibility. Perhaps, however, the consideration of a series of cases that have attracted widespread attention, and which have been most carefully investigated in all their circumstances, may present the methods of responsible determination better than any set of rules. Three presidents of the United States have been murdered within forty years. The murderers were native-born [{303}] Americans. In none of the three cases was there any adequate motive for the commission of the crime. The assassin in President Lincoln's case might, it is true, be presumed to have a sufficient political motive, but no entirely sane man could have thought for a moment that any good would be accomplished at that time for the South by the removal of Lincoln. A man of known erratic tendency, with the craving for theatrical effects deeply ingrained in his nature, with a personal history not entirely free from even more serious manifestations of mental disequilibration, and with a family history of more than suspicious character as regards the mental qualities of his ancestors, committed the crime. He met his death at the hands of pursuing soldiers. Such was the temper of the time, that had he been captured alive he would surely have suffered the formal legal death penalty. Even as it was, public sentiment clamoured for legal victims and unfortunately they were found.

It seems clear, beyond all doubt, that in this case complete responsibility for his action was not present in the assassin himself. The courts decided later that there had been a conspiracy, but there has always been the feeling that justice was misled by over-zeal to find scapegoats for injured public sentiment. There is no doubt that it is an extremely difficult matter to say what shall be done to the assassin in such a case. The unfortunate result is as much an accident as the fatal consequences of any other perverted natural force. An earthquake may kill its thousands and the inevitable must simply be accepted. Society may protect itself from the further manifestations of such perverse individuals by confining the unfortunate murderer for life, but capital punishment, in the sense of a sanction for broken law, can scarcely be considered to have a place in the given conditions.

With regard to the murderer of our second assassinated President we had the farce of a long-drawn-out public trial of a man who was evidently not in his right senses. Once more a victim had to be found to satisfy injured public feeling. Guiteau was condemned to death and suffered the death penalty. Any one who reads the proceedings of the trial and who realises the significance of the motive that Guiteau [{304}] himself gave for his act, will appreciate that the court had to do with an irresponsible doer of a material but not a moral wrong. There were many signs of mental disequilibration in Guiteau's previous career. It is on these eventually that the expert in mental diseases must depend in order to enable him to obtain a proper estimate of the extent of the mental disturbance in any given individual. It may seem that many real criminals can be defended on this same principle of finding an inadequate motive for their crimes. There are, however, certain signs of irrationality not difficult to detect if the previous life of the individual be carefully scrutinised and these must form the ultimate criterion as to criminal responsibility.

With regard to the third murderer of a President the case is clear. He was an ignorant, somewhat conceited individual, but he presented none of the signs of true mental disequilibration that can ordinarily be depended on to indicate such a disturbance of the physical basis of mind as impairs responsibility. He was not entirely without a motive, which in the mind of a brooding, conceited individual, might seem to be adequate for the commission of the crime. His sentence of the death penalty was then in accord with the judgment of the best mental experts. How society shall protect itself, and especially its high officials, against such notoriety seekers is hard to say.

The consideration of these cases gives a clear idea of how a physician endeavours to fill up gaps in his knowledge of the character of the man, his heredity and environment, as well as his previous actions at various times in life when under the stress of emotion. It may be considered that such a weighing of circumstances will serve to excuse many genuine criminals who eminently deserve to be punished. This is, however, the assumption of the older generation who considered that if a man did a material wrong he must be punished for it. It is a heritage of the day, when even accidental killing was considered to demand some punishment. At the present time the tendency is rather to consider only the moral wrong, that is, to calculate responsibility only for such actions as are committed with due [{305}] deliberation, intention, and the knowledge of right and wrong as well as the freedom to perform the action. The old English legal opinion which declared a man responsible if he knows that what he is doing is wrong has now given way in most judicial proceedings to the principle that the man must not only know that he is doing wrong, but that he must also realise that he is free not to do that which he knows to be wrong. That is to say, if he feels himself compelled to the commission of crime, there is surely an impairment of responsibility. Such impulses to do wrong without adequate motive occur not infrequently among those whose mental condition is not perfectly normal, and this must always be taken into consideration in the ultimate decision as to their responsibility for their action.