A study of the "excitable" psychopaths in Kraepelin's[344] clinic showed the intellectual standard of these individuals to be above the average. Apprehension and judgment were unimpaired even when mental inferiority was not entirely lacking. Some complained of poor memory or absentmindedness, others of a feeling of fatigue. A definite mental activity was noted, usually of a happy mood, but occasionally with depressive tendencies. The characteristic feature was an emotional excitement, associated often with violent rages, without any adequate reason. The emotional reaction changed quickly to one of despair, anxiety, irritability or inaccessibility. The mood in a large number of cases was depressed and tearful, while others were cheerful and elated, laughing and joking, or erotic. Often without any apparent cause, irritability, pessimism, unsociability, weariness of life and thoughts of suicide appeared—more particularly during menstrual periods. The emotional state as a rule was kind, affable, good-natured, tractable, often religious, sensitive or sympathetic. The patients are often spoken of as well-liked, industrious, honest and substantial citizens. Some are timid, bashful or gloomy in disposition. Others are conceited, overbearing, tyrannical, rude, unsociable and quarrelsome. Many are childish, foolish or eccentric, highstrung and affected or untruthful. Some are unsteady, restless and over-occupied, full of schemes, rash, talkative, gossiping, and assuming striking mannerisms. Occasionally they are disinclined to any regular occupation, neglect their work, loaf around and are supported by their relatives. In sixty-two per cent of these cases the patients were brought to the clinic on account of suicidal tendencies. This was due to reduced circumstances in nearly fifty per cent of the men and in seventy-one per cent of the women. In the men marital troubles and love affairs were more common; sometimes loss of position, or death in the family, etc. Spurious attempts at suicide of a theatrical type were frequently reported. Next to suicidal inclinations as a cause for being brought to the clinic there were assaults, attacks of rage and outbursts of despair. In any stress or anger over a disagreeable occurrence these individuals are likely to become abusive, shout, scream, run around, strike the head against the wall, tear their clothes off, pull out their hair, etc. Some rush around all night in the streets in a senseless rage, improperly clothed. Occasionally they attack others unjustifiably and for no apparent reason. They are exceedingly susceptible to alcohol. During their excitements, consciousness may be clouded. Afterwards they say they were confused, not themselves, in a dream as it were, etc. Some have no recollection whatever as to what was done. These excitements rarely last more than a few hours. Thirty-two per cent of the men and less than ten per cent of the women were convicted of crime, usually for disturbing the peace, or criminal assaults, but occasionally for much more serious offenses. As a rule alcohol is a factor in these cases. The relations between the sexes are characterized by jealousy and quarreling. The women are particularly likely to have delusions of infidelity. Genuine hysterical attacks occur in a certain number of cases. They often see visions and may have dizzy spells or syncopes. Somnambulism may occur. Nervous symptoms often appear—headaches, unpleasant dreams, palpitations, tremors, increased reflexes, tics, etc. The excitable cases constituted nearly one-third of the psychopaths admitted at Kraepelin's clinic. Sixty per cent of these were women. The majority of cases were between fifteen and twenty-five years of age. Heredity appeared to be a factor in forty-seven per cent and many showed physical defects. Fifty per cent of the men were intemperate.
The "unstable" psychopaths are characterized by a dominating weakness of the will. In nearly one-half of the cases the intellectual endowment is normal, some having a surprising power of comprehension and ability to take up new things, with accurate observation of their surroundings and keen discrimination. These persons have no great persistence and do not exert themselves, are inattentive, tire easily and are distractible. They never go into things deeply and have only a superficial knowledge of events. They learn readily and forget quickly. The memory is poor and unreliable. The imagination is usually very active, with a tendency to exaggerate, dream of the impossible and relate great stories. There is an inclination to boast and fabricate, telling of wonderful but wholly imaginary deeds and accomplishments. They often represent themselves to be important personages. Some show artistic talent, write plays or fantastic poetry and discuss literary and dramatic problems. They are strongly inclined to become actors. The higher intellectual development is uniformly defective. Comprehension is not clear and judgment is immature and short-sighted. Their interests are devoted to frivolous matters without much attention to more important questions. They sometimes show great prospects in school but do not fulfill them later. The mood is cheerful and conceited, with a very high opinion of themselves and great ambitions. They blame their relatives for their lack of success and claim they are not understood or appreciated. Sometimes the emotional trend is more sad and gloomy. They complain of being unlucky, everything goes wrong. Occasionally anxieties appear, with a feeling of oppression, fear of being alone, of mental troubles or suicide. These feelings are, however, superficial in character, usually disappearing in a short time, to be followed by excitement, outbursts of anger or anxiety. They are often quarrelsome. The characteristic disturbance, however, is that of the will. They are entirely lacking in the capacity to stick to any one occupation. They are not punctual, are interfered with in innumerable ways and often change their work, looking for something more suitable. Hypochondriacal notions hamper their activities. Senseless journeys and trips are often undertaken. Some become vagabonds and tramps. They are much inclined to bad company and resort to immoderate use of tea, coffee, drugs and alcohol. Sixty-four per cent of Kraepelin's male cases and twenty per cent of the women were intemperate. The sexual habits are very often irregular and venereal diseases to be expected. Kraepelin found either gonorrhea or syphilis in twenty-two per cent of the women examined. Some exhibited homosexual tendencies. Many become spendthrifts, making extravagant and foolish purchases. They are inclined to speculate unwisely. Fifty-four per cent of the men and nearly a third of the women as a result of their moral deterioration come into conflict with the courts on account of thefts, assaults, quarrels, vagrancy, etc. Suicidal tendencies were shown in forty-eight per cent of the men and sixty-five per cent of the women in Kraepelin's clinic. In many cases these were induced by alcoholism, in other instances by family quarrels, etc. Often the reasons given were foolish. Hysterical attacks appear in a certain percentage of cases in the women. Some had hallucinations and confusional attacks or syncopes. Tremors, headaches, increased reflexes and other neurological symptoms occasionally appeared. The "unstable" group included about one-fifth of the psychopaths observed by Kraepelin. Thirty-six per cent of these were women. The majority of those admitted were between the ages of fifteen and twenty-five. Heredity was a factor in forty-nine per cent of the cases.
The "impulsive" psychopaths are characterized by a domination of the conduct by emotional impulses. The intellectual makeup of these individuals is usually good. They often have a special bent for art, music, poetry, etc. They frequently show a considerable mental activity and versatility. They express themselves well, make witty remarks and appear brilliant, although they may complain of absentmindedness or fatigability. They are always conceited, born to greater things and have a great future. There is an almost unbounded egotism in some cases. The emotional tone is good-natured, easygoing and accessible. Many are sensitive and visionary; others obstinate, inconsiderate, pretentious or quarrelsome. The mood is usually high-spirited and confident but variable. The patients are often depressed and hopeless, complaining of their luck. At other times they are sullen, surly, irritable and faultfinding. Many exhibit suicidal tendencies. An emotional irritability is exceedingly common, with violent outbursts of anger. Often they refuse to associate with others for a time and will speak to no one. The three common types are the spendthrift, the wanderer and the dipsomaniac. The spendthrifts usually indulge in alcohol and naturally soon contract enormous debts. They frequently have little insight into their condition or blame someone else for it. Many become wanderers and go aimlessly from one place to another—wherever their inclination leads them. The memory for these events is good. Some inadequate reason is always offered. These wanderers usually are children between the ages of ten and fifteen. The impulsive alcoholics may have attacks very rarely, sometimes only once a year. Debauches are preceded by restless and moody conduct. After constant drinking for days or weeks they sometimes have suicidal impulses. Sexual excitements may occur. They always show psychopathic traits between attacks. They are unsteady, unreliable, make sudden resolutions, change their occupations and residence and lead a wild existence with surprising adventures. Some have hysterical attacks, fainting spells, or even convulsions. The impulsive psychopaths constituted only two or three per cent of Kraepelin's cases. Practically all were over twenty-five years of age. There was a hereditary taint in seventy-one per cent of the cases.
The "eccentric" psychopaths are characterized by a lack of uniformity and consistency in the mental makeup. The intellectual endowment of these individuals is usually normal. They are often absentminded, forgetful and show a variation in productivity. Some are artists or devote themselves to inventions. Judgment is impaired and reasoning becomes distorted and onesided. There is a tendency towards exaggeration and extravagance in their viewpoints, with a leaning towards queer notions. They are often quickwitted, versatile and write long and wordy documents. Their mode of expression is bombastic and labored, and the content of speech or writing, verbose, desultory, flighty and full of meaningless expressions. They show a certain shrewdness and cunning, dissimulate, resort to all kinds of evasions, and are conspicuous in their conduct. Occasionally there is a tendency towards delusional ideas of a mild form. As a rule the mood is cheerful, although often depressed, suspicious or irritable. They are opinionated, boastful and better than others. Usually there is an emotional excitability. The patients are sensitive and irritated by small things, scold and complain. Sometimes they are sentimental and dreamy, with extravagant language. They often take sudden dislikes to brothers, sisters or other members of the family. They are capricious, quarrelsome, and faultfinding. Their conduct is aimless, contrary and incomprehensible. They lose all capacity for judgment of real conditions. They cannot proceed in any orderly way in things which they are really fitted for. They do not stick to anything long, changing plans and occupations frequently. They often go about at night talking, arguing and drinking. It is not unusual for them to quarrel with their wives or even commit assaults. The majority of these eccentric psychopaths were men over thirty-five and of degenerate families. This group constitutes only a small number of cases.
The "liars and swindlers" are characterized by an excitability of the imaginative faculties and a variable and uncertain will power. At first these individuals are likely to appear as unusually gifted persons. They are good-natured, present an excellent appearance and are apparently well informed on almost all subjects. They have a faculty for quoting foreign languages and sometimes are familiar with many tongues. Often they are brilliant conversationalists. On investigation their actual knowledge is found to be very superficial. They are inclined to art, poetry and literature. Many become interested in hypnotism or spiritualism. They are inclined to join religious sects or attach themselves to the Salvation Army. These individuals learn quickly but do not stick to things long. Their mental powers are not orderly or consistent. They have an extraordinary imagination but accomplish nothing. They are liars from birth, the falsifications usually being entirely useless. Many are anonymous letter writers. They are often unable to discriminate, themselves, between the true and the false in their own stories. These fabrications appear to be an emotional product, the imaginary occurrence practically always relating to the individual himself. They boast of their superiority in literary and scientific accomplishments and claim to be theologians, mathematicians, jurists, chemists, etc. In their imaginations and fabrications the patients always better themselves. In many instances they assume pretentious titles, represent themselves as counts, princes, etc. Sometimes they strongly suggest paranoia. In a small number of cases self-accusations appear and they confess to all kinds of imaginary crimes. As a rule they are elated and optimistic, but often affected and theatrical. Occasionally suicidal attempts are made. At times general depressions or anxious states appear. Some are coarse and deceitful. They are usually uncertain and capricious in everything. Some become spendthrifts. They are naturally cheats and swindlers; occasionally thieves. The swindling schemes resorted to are innumerable. The use of false names and assuming of uniforms and titles of various kinds is the most common. They make purchases of all kinds without any ability to pay or any intention of doing so. Many refuse to pay bills without any excuse whatever. Others attempt to marry rich women by deceitful means and misrepresentations. Some practice medicine without a license; others claim damages for imaginary injuries. Sexual offenses are common. If arrested they are often inclined to claim amnesia for the period of time when the act was committed. They occasionally have genuine psychoses and hysterical attacks. These simulate various diseases. The group of liars and swindlers constituted from six to seven per cent of the psychopaths in Kraepelin's clinic. Seventy-one per cent of the men were accused of crimes. The majority of cases were under twenty-five years of age. Heredity was a very important factor.
The "antisocial" psychopaths or enemies of society are characterized by a blunting of the moral elements of their makeup and a lack of adjustment to their environment. Kraepelin found that forty per cent of his cases were persons who had done well in school. They have a strong dislike for regular occupations and avoid them in every possible way. Their behavior is variable, with a tendency to be industrious occasionally and more often lazy. Frequently they appear queer, abstracted, inattentive, dreamy, sleepy or dull. When at their best they are not bright mentally and have no ambition or far reaching interest. They learn quickly and forget as rapidly. Their store of knowledge is very limited. They have no capacity for going into things thoroughly and cannot acquire a higher education. They are lacking in judgment, foresight and discrimination. Many have a weakness for cheap stories of adventure, pictures of crime, etc. In expression they are usually quick as well as verbose. A characteristic is their lack of truthfulness. They are liars and braggarts. The mood is usually cheerful and confident; sometimes arrogant, surly, moody, irritable and occasionally depressed or anxious. They change unexpectedly from one mood to the other. Irritability, with outbursts of anger, is common. They often become threatening and destructive. Eighteen per cent of Kraepelin's cases attempted suicide. At least one-third of these were theatrical attempts on account of fear of punishment. Childish vanity and conceit is a very common symptom, with boastful tendencies. A prominent feature is the lack of any deep emotional reactions. They do not react normally and properly to their surroundings. Another characteristic defect is their entire lack of sympathy for anyone else. They are likely to be cruel to animals as well as persons. They show little affection for parents, children or relatives and are lacking in a sense of decency and personal cleanliness. As children they are exceedingly troublesome in school. Some have to go to custodial institutions for care. Many are truants at school and run away from home, becoming wanderers and vagabonds. They are inclined to sexual excitement, irregularities and crimes of various sorts. Seventy per cent of Kraepelin's cases were thieves, beginning to steal as children; twenty per cent were embezzlers and twelve per cent guilty of fraud or forgery. Practically every variety of crime was represented. They exhibit an extraordinary tendency to revert to criminal habits. Prison life makes some submissive but starts others in a war against society. They often attempt violence or make passive resistance to the law. They occasionally develop hypochondriacal tendencies. Friendly advances are greeted with mistrust. Some are stubborn, sulky, unrepentant and have nothing to say, or lie and explain by putting the blame on others. Thus an opposition to all organized society develops. They often look upon themselves as martyrs. Others take the situation lightly and minimize the gravity of their position. Some seem to really see the error of their ways. The antisocial individuals sooner or later, like other psychopaths, are very prone to hysterical attacks, fainting spells, or even convulsions. Anesthesias and hyperesthesias may be noted. Some patients complain of headache, disturbed sleep, dreams, etc. The antisocial in Kraepelin's clinic constituted less than ten per cent of the psychopaths, of which seventy per cent were men. Half of the women were prostitutes. Over eighty per cent of the cases were under twenty years of age.
The intellectual makeup of the "quarrelsome" psychopath is usually fairly good. As a rule these persons show a narrowing of the intellectual sphere, with, however, a well-defined shrewdness which enables them to take advantage of others. Some show a tendency to pedantry and hair-splitting arguments. Memory is good but distorted by an emotional coloring. Judgment is warped and unreliable. They are credulous and accept statements without proof, but they look with suspicion on anything not in accord with their own ideas. The influence of these factors leads to an emotional excitability. They are always passionate, sensitive individuals who become excited over trivial matters. This is complicated by a marked self-confidence, minimizing their own failings. Quarrels are the inevitable consequence. Everything is exaggerated in importance. The conclusion is reached that the neighbors and others are all organized against them. Sometimes the feeling of enmity is transferred from one individual to another. The patient is constantly in trouble with someone. They are almost invariably of the male sex and usually of middle age or older when they come under observation.
For statistical purposes the differentiation of the psychopathic personalities has been described by the Association's committee as follows:—
"Under the designation of psychopathic personality is brought together a large group of pathological personalities whose abnormality of makeup is expressed mainly in the character and intensity of their emotional and volitional reactions. To meet the demands of current usage, the term for this group has been shortened from the older one "psychoses with constitutional psychopathic inferiority" with which it is synonymous. Individuals with an intellectual defect (feeblemindedness) are not to be included in this group.
"Several of the preceding groups, in fact all of the so-called constitutional psychoses, manic-depressive, dementia praecox, paranoia, psychoneuroses, etc., may be considered as arising on a basis of psychopathic inferiority or constitution because the previous mental makeup in these conditions shows more or less clearly abnormalities in the emotional and volitional spheres. These reactions are apparently related to special forms of psychopathic makeup now fairly well differentiated, and the associated psychoses also have their own distinctive features.