With regard to women especially, it must be remembered that there is for them a period between the ages of forty [{250}] and fifty, during which for several years they are extremely unsuited for the responsibilities and exacting duties of a Superior. These years prove even to mothers of families, surrounded only by their own children and the ordinary circumstances of home life, a time of worry and irritation that plays sad havoc even with the best of dispositions. Mothers constantly complain to their physicians of an irritability of temper which they can scarcely account for, and which makes them do and say things which they are extremely sorry for afterwards. It is easy to understand, then, that a Superior with still more insistent duties when brought in contact with a number of persons, some of whom are almost sure not to be entirely sympathetic, is likely to suffer from irritation that is not a sign of absence of a fitting religious disposition, but only a physical manifestation of the physical strain through which she has to pass at this time of life. The years of the menopause, to be very plain, should not be allowed to make a Superior's life miserable and to add to the difficulties that a religious community always has to face in its relations to its Superior and to one another. Charcot, the distinguished French neurologist, used to say that women should never be asked to assume special responsibilities during the days of their monthly period, for their judgments are often warped by their physical condition. It is doubtful whether, in the majority of normal women, this is quite true, though the expression deserves to be remembered. There is no doubt, however, that the years of the change of life do bring on very serious modifications of the character of the individual, and occasionally these changes are lasting.
JAMES J. WALSH.
XXII
EPILEPSY AND RESPONSIBILITY
From the very earliest times epilepsy has been looked upon as a mysterious and in many ways an inexplicable disease. The Romans spoke of it as the malum comitiale, the comitial disease, because if an attack of it occurred during the meeting of the Roman people known as the comitia, in which municipal officers were elected and other city business transacted, an adjournment was at once moved, and no further proceedings were considered valid. During more modern times, especially during the middle ages, and almost down to our own time, those affected by the disease frequently came to be looked upon as the subjects of possession by the devil. Hysterical manifestations were even more frequently considered signs of possession (diabolical manifestations) but even in our time it is not always easy to make the distinction between certain forms of hysteria and epilepsy. Many of these sufferers were considered as not responsible for their actions. In this respect, at least, the advance of modern medical science has only served to confirm the popular impression of less sophisticated times, and it has come to be recognised that quite a large number of the sufferers from epilepsy must be deemed lacking in responsibility.
There are few nervous diseases that have been more studied than epilepsy, and yet, because the ailment involves so intimately the relations of the nervous system and the bodily function, there are few diseases of which less definite opinions can be given. This is especially true as regards prognosis and the question of mental deterioration in any given case. As a matter of fact the extension of our knowledge of epilepsy, far from making the question of the responsibility of the [{252}] epileptic under trying circumstances more easy of solution, has rather served to show how difficult this problem must ever remain.
There are many forms of the disease,—the frank epileptic convulsion in which patients fall down, are seized with certain convulsive movements, become pale and lose consciousness for a time and then come to with an intense feeling of weariness which usually prompts them to sleep for some hours—too familiar to need further description. There are forms of epilepsy, however, quite different from these. In some cases, the attacks occur only at night, and unless the patient happens to be watched for some reason, there may be no trace of their occurrence, except perhaps a sore tongue where it has been bitten, or an intense feeling of weariness and depression in the morning. In still other cases, the physical signs are lacking almost entirely. There may be only a momentary loss of consciousness. A distinguished professor of medicine in this country used to have a momentary attack of confusion, during which he lost the thread of his discourse, and always within a minute, with a somewhat flushed face, he was able to go on, though he had to begin with another idea. The so-called psychic epilepsy, in which the symptoms are entirely mental and consist of some marked change of disposition for a time, are now universally conceded as constituting well-marked phases of the disease. Curiously enough it is with regard to these obscure cases, uncomplicated by serious physical manifestations, that there is most mystery; and they seem to affect the mentality and to disturb volition and responsibility more than the supposedly severer forms which cause convulsive attacks and are so easy of recognition.
Certain forms of masked or psychic epilepsy constitute the most puzzling problem that the expert in nervous and mental disease has to deal with where criminal acts are performed, apparently without sufficient motive, and yet where the limits of responsibility must if possible be determined. It is easy to dismiss these cases and to consider that because a certain amount of intelligence has been displayed in the performance of the act, and because the patient ordinarily understands perfectly the distinction between good and evil. [{253}] that therefore the will must have been entirely free in the accomplishment of the criminal action and the intellect must have understood what it was doing. As yet the general public refuses to take the standpoint of the expert in mental diseases in many of these cases; and only when clergymen also shall come to a realisation of the pathological elements undermining free will in these cases, that justice will be properly tempered, not by unworthy or misplaced charity, but by the mercy which, knowing all, has learned duly to appreciate what is and what is not criminal.
Epilepsy, in certain of its obscurer forms, is responsible for many conditions in which there is a sudden access of insane excitement of a violent, often very impulsive, character, though sometimes of very short duration. During this state the patient is practically irresponsible, and yet he may have sufficient control over his actions to enable him to work serious harm. Such a stage of excitement may last not more than an hour or two; usually all trace of it passes off in a day or two; before and after it the patient may be in perfectly sound sense and in apparently good health. One of our best authorities here in America, Berkley, in his treatise on Mental Diseases, gives the following striking opinion on this subject.
"The subject of masked epilepsy and the consequent mania is replete with interest to the physician and the jurist, since such patients are prone to impulsive acts of violence and automatic states in which the most complicated, but entirely unconscious, actions and crimes may be carried out without premeditation on the part of the sufferer, being also out of all accord with his character during his intervals of mental health. Besides the irritability, impulsiveness is an equally characteristic feature. No form of insanity more frequently gives rise to assaults and murder than epilepsy, and in no form of alienation is the physician so frequently called to the witness stand to determine the responsibility of the criminal."