CHAPTER XVII
THE PSYCHOSES WITH PSYCHOPATHIC PERSONALITY

The introduction of the term psychopathic personality is probably to be attributed to the description of "Die Psychische Minderwertigkeiten" by Koch in 1893. These were referred to by Morel[337] as "Psychopathic Depreciations," a group in which he says Koch included "a very large number of these psychical manifestations, so varied in their nature and intensity which, without belonging to the class of mental diseases proper, cannot, nevertheless, be reconciled with the idea of perfect mental sanity." These were described as being either congenital or acquired and including psychopathic predisposition, psychopathic defect and degeneration. To congenital defects were attributed the "Eccentrics, disequilebrated, overscrupulous and capricious persons, foolish, misanthropes, redressers of wrong, reformers of society, etc." In the degenerative processes he included mental deficiencies both intellectual and moral. Meyer,[338] who based his conception of "constitutional inferiority" largely on the work of Koch, says that the latter by "Psychische Minderwertigkeiten" "meant those little defects which constitute the inferiority of the individual in the whole strife of life, that inferiority which does not allow him to come up to an actually efficient balance in the struggle of life.... They were oddities, peculiar nicks in the personalities of the various people, and he designated those as constitutionally inferior." Koch in this grouping unfortunately included hysteria, psychasthenia and neurasthenia. Meyer eliminated these: "I wanted to do justice to the hysterias and psychasthenias which I could define as such, but I knew there was a whole group of cases in which the definition could not be pushed. I also knew that it was difficult to give the definition in the downward line towards imbecility, and since it was so very hard to give the definition in the individual cases, I thought that the least trouble would arise from making a relatively large group of 'inferiorities not sufficiently differentiated' and let those be entered under the heading of 'constitutional inferiority.'"

The original conception of this group was that it included intellectual defects which have subsequently been classified with the mental deficiencies, leaving only those cases showing purely psychopathic taints of a constitutional origin. There have been numerous other descriptions of these conditions. Ziehen[339] included under the psychopathic constitution "chronic, psychopathic conditions, which in their symptomatology and course not only involve defect of the affectivity but also of the intelligence, even though pronounced psychopathic symptoms, such as delusions, hallucinations, etc., do not intrude for any extended period. Where hallucinations and analogous symptoms do appear they are solitary and the patient retains insight into the condition." Ziehen's psychopathic constitution covers a very wide field, including not only hysteria and neurasthenia but epilepsy.

The psychopathic personalities as described today represent only a modern interpretation of conditions which have been given ample consideration in the psychiatric literature of the past. An early illustration of this fact is Pritchard's definition of "moral insanity" in 1835:—"A morbid perversion of the feelings, affections and active powers, without any illusion or erroneous conviction impressed upon the understanding; it sometimes coexists with an apparently unimpaired state of intellectual faculties." The psychopathic states were undoubtedly fully covered in Morel's description of the insanity of degeneracy in 1860. This he divided into cases arising from constitutional nervous temperaments, moral insanity, the feebleminded with or without morbid impulses, and those with criminal tendencies. This conception was well summarized by Diefendorf [340]:—"The disharmony of the intellectual and the moral faculties is one of the most striking features of degeneracy. As in the defects of the intellectual development, so in the moral sphere, the condition varies from a complete arrest of moral development to all forms of moral perversion and even to an abnormal development of the moral and emotional susceptibility. All of these conditions may exist, with a perfect development of the intellectual faculties.... The professional criminals should also, without doubt, be included in this class, as they present all possible varieties of moral perversions and anomalies, all of which may exist with preservation of the intellect and even with intellectual keenness."

Magnan described compulsions, impulsions and contrary sexual instincts as episodes of the insanity of degeneracy. The psychopaths were undoubtedly the "déséquilibrés" or ill-balanced individuals of Régis,[341] whose work on "Mental Medicine" included an exceedingly elaborate discussion of the so-called "borderline" conditions. "After maturity they are complex beings, heterogeneous, made up of disproportioned elements, contradictory qualities and defects, and as over-endowed in some directions as they are deficient in others. Intellectually, they often possess in a very high degree, the faculties of imagination, of invention, and of expression, that is to say, the gifts of speech, the arts, and poetry; on the moral side, they possess a singular emotivity, or rather, sensibility. What they lack, more or less completely, is good judgment, the moral sense, and especially continuity or logical consecutiveness, a unity of direction in intellectual production and the actions of life. It follows, that in spite of their often superior qualities, these persons are incapable of conducting themselves in a rational manner, of following regularly the exercise of a profession that seems well beneath their capacity, of looking after their interests or those of their families, of carrying on business prosperously or of directing the education of their children; their existence, therefore, constantly recommencing, is one long contradiction between the apparent wealth of means and poverty of results. They are the utopians, the theorists, the dreamers, who are enamored with the best things but accomplish nothing. The public which sees only the brilliant exterior looks upon these individuals as artists and superior beings. The medal is reversed, however, to those who are compelled to associate with them and share their existence; they see their defects, their incapacities and evil tendencies, of which they are not merely the witnesses, but also the victims. Aside from their lack of mental poise these individuals also display an excessive emotional sensibility and an enfeeblement of psychic energy that reveals itself by a noticeable predominance of spontaneity over reflection and volition. Hence their inability, their instability, and their irresolution; hence also their alternations of apathy and activity, of excitement and torpor, their violent attacks of passion and their cries of despair for the most trivial and slightest reasons." Régis divided the "psychic discordances" or disharmonies into the ill-balanced, the original and the eccentric. These were all included in the degeneracies of evolution. Clouston covers this same ground fully and in a somewhat similar manner in his "Unsoundness of Mind" (1911).

The insanities of degeneracy have also been given considerable space by such Italian writers as Lombroso, Bianchi, etc. Lombroso in "The Man of Genius" (1888) discussed this subject as follows:—"A theory, which has for some years flourished in the psychiatric world, admits that a large proportion of mental and physical affections are the result of degeneration, of the action, that is, of heredity in the children of the inebriate, the syphilitic, the insane, the consumptive, etc.; or of accidental causes, such as lesions of the head or the action of mercury, which profoundly change the tissues, perpetuate neuroses or other diseases in the patient, and, which is worse, aggravate them in his descendants, until the march of degeneration, constantly growing more rapid and fatal, is only stopped by complete idiocy or sterility. Alienists have noted certain characteristics which very frequently, though not constantly, accompany these fatal degenerations. Such are, on the moral side, apathy, loss of moral sense, frequent tendencies to impulsiveness or doubt, psychical inequalities owing to the excess of some faculty (memory, aesthetic taste, etc.) or defect of other qualities (calculation, for example), exaggerated mutism or verbosity, morbid vanity, excessive originality, and excessive preoccupation with self, the tendency to put mystical interpretations on the simplest facts, the abuse of symbolism and of special words which are used as an almost exclusive mode of expression."

Several other very elaborate works have been published on the subject of degeneracy. One of the better known of these perhaps is that of Max Nordau on "Degeneration" (1894). The book of Grasset[342] on the "Demifous et Demiresponables" has been translated into English and constitutes one of our most valuable contributions on this subject. Grasset credits Trélat with making the first comprehensive study of the semi-insane in his "La Folie Lucide," etc., in 1861. His classification of these conditions included imbeciles, the feebleminded, satyrists, nymphomaniacs, monomaniacs, erotomaniacs, jealous individuals, dipsomaniacs, spendthrifts, adventurers, the conceited or boastful, evildoers, kleptomaniacs, suicides and the inert and lucid manias. Grasset gives some interesting illustrations of the psychopathic traits of various men of genius. Tolstoï fell sixteen feet as a result of attempting to fly when eight years old, and whipped himself with ropes to become accustomed to pain. In school he chose a course in Oriental languages because everyone else was interested in law. Not being able to finish a college career in two years, he decided to go to a desert and live a purely animal life. It was necessary for him to resort to devices of various kinds to prevent suicide. Rousseau was at various times a clockmaker, music master, painter and servant in addition to studying medicine, music, theology, and botany. He dedicated a pamphlet "to all Frenchmen who were friends of justice" and distributed it on the streets. One of his acts was to write a letter "to God Almighty" and place it under the altar of Notre Dame. Persecutory ideas were entertained by him for years. Emile Zola was evidently a psychasthenic as well as a psychopath. He counted the gas jets on the street, the numbers on the doors, and the cabs passing by. These were added together. "For a long time the multiples of three seemed to him of good omen, then the multiples of seven were reassuring." "For a long time he was afraid he would not succeed in any proceeding on which he was about to enter if he did not leave the house with his left foot first." Balzac had an ambulatory mania and could not be found when called for military service. It is said that on one occasion "when he had put on a handsome new dressing gown he wanted to go out into the street with it on with a lamp in his hand to excite the admiration of the public." His father is said to have stayed in bed for twenty years without any reason for so doing, suddenly resuming his former mode of life at the end of that time. Schopenhauer broke a hotel proprietor's arm because he heard him talking outside of his room. He refused to pay a legitimate account because his name was spelled with two p's instead of one, on the bill. He often burned his beard instead of shaving and wrote his notes in Greek, Latin and Sanskrit for fear someone would read them. In his will he left all of his possessions to soldiers and to his dog. Goethe alternated between great joy and extreme depression and had unjustifiable attacks of anger. Frederick II had such a dislike for changing his coat that he had only two or three during the course of his life. When Schiller wanted to meditate he had a habit of putting his feet on ice and sniffing the aroma of fermenting apples. Nordau says "that Richard Wagner is accused of having a greater degree of degeneracy than all the degenerates that we have thus far seen put together." Mozart played the harpsichord at three years of age, composed concertos at five and made a concert tour at the age of six. He was extremely nervous and fell in love at fifteen with a girl of twenty-five. In the last months of his life he was obsessed with the idea that he had to prepare his own funeral mass. Lombroso's theory is that "genius is a true degenerative psychosis, belonging to the group of moral insanities which may temporarily spring from other psychoses and take their form, but always conserving certain special characteristics which distinguish it from the others." Although his conclusions may not be warranted it must be admitted that many men of genius have been psychopaths.

Kraepelin[343] in discussing the influence of heredity on psychoses and personalities, says, "Hence we may, perhaps, discriminate between congenital states of disease and morbid personalities, according as the disturbances are apparently the expression of the morbid conditions of past generations, or seem to be purely personal abnormalities, although it is certainly impossible to make any sharp distinction." In 1915, in the fourth volume of his eighth edition, Kraepelin devoted nearly one hundred and fifty pages to the subject of psychopathic personalities. These he divides into the excitable, the unstable, the impulsive, the eccentric, the liars and swindlers, the antisocial or enemies of society, and the quarrelsome.