"There remain, however, various other less well differentiated types of psychopathic personalities, and in these the psychotic reactions (psychoses) also differ from those already specified in the preceding groups.
"It is these less well differentiated types of emotional and volitional deviation which are to be designated, at least for statistical purposes, as psychopathic personality. The type of behavior disorder, the social reactions, the trends of interests, etc., which psychopathic personalities may show give special features to many cases, e.g., criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities.
"The pronounced mental disturbances or psychoses which develop in psychopathic personalities and bring about their commitment are varied in their clinical form and are usually of an episodic character. Most frequent are attacks of irritability, excitement, depression, paranoid episodes, transient confused states, etc. True prison psychoses belong in this group.
"In accordance with the standpoint developed above, a psychopathic personality with a manic-depressive attack should be classed in the manic-depressive group, and likewise a psychopathic personality with a schizophrenic psychosis should go in the dementia praecox group.
"Psychopathic personalities without an episodic mental attack or any psychotic symptoms should be placed in the without psychosis group under the appropriate subheading."
Unfortunately there are no statistics which show the incidence of psychopathic personalities in the community. A study of 70,987 first admissions to state hospitals shows that the psychoses associated with this condition constituted only 1.12 per cent of the total number. On the other hand, the reports of the Phipps Psychiatric Clinic show an admission rate for psychopaths of over six per cent during a five-year period. When they reach a state hospital it is usually owing to the development of manic-depressive insanity or some other well-defined psychosis. The important and troublesome cases from a social point of view are those that do not reach hospitals. A much larger percentage is to be found in institutions of the correctional and penal type. There is no greater problem today than the attitude of the state towards the psychopathic criminal. The influence of these individuals on the community at large is something that we have no means of estimating at the present time.
CHAPTER XVIII
THE PSYCHOSES WITH MENTAL DEFICIENCY
The literature of mental deficiency is almost as old as that of medicine. Imbecility was studied at some length by Plato and Galen and was recognized by Felix Plater, who has been accredited with the first classification of mental diseases known (seventeenth century). Fitzherbert[345] in his "Natura Brevium" in 1652 included the following interesting definition of idiocy: "He that shall be said to be a sot and idiot from his birth, is such a person who cannot count or number twenty pence, nor tell who was his father or mother, nor how old he is, so as it may appear that he hath no understanding or reason what shall be for his profit, or what for his loss; but, if he have sufficient understanding to know and understand his letters, and to read by teaching or information, then it seems he is not an idiot." One of the first medical writers to discuss mental defects at any length was Esquirol. In differentiating them from mental diseases he said: "Idiocy is not a disease, but a condition in which the intellectual faculties are never manifested; or have never been developed sufficiently to enable the idiot to acquire such an amount of knowledge as persons of his own age, and placed in similar circumstances with himself, are capable of receiving. Idiocy commences with life, or at that age which precedes the development of the intellectual and affective faculties, which are from the first, what they are doomed to be during the whole period of existence." ... "A man in a state of Dementia is deprived of advantages which he formerly enjoyed. He was a rich man, who has become poor. The idiot, on the contrary, has always been in a state of want and misery." An elaborate treatise on the subject of cretinism was published by Fodéré in 1792.