Experience has shown that the defective criminal classes are not suitable cases for either penal institutions or hospitals for the insane. They are unable to adapt themselves to prison discipline or hospital routine and prefer to associate only with persons of their own kind who are given to foolish boasting of their crimes as their least harmful diversion. They are entirely unappreciative of any efforts made on their behalf to improve their condition or fit them in any way for the requirements of society. They are strongly inclined to unprovoked cruelty to others. Often they manifest an apparent interest in religious services, thinking it may lead to some preferment, but not for any moral reason. They are notoriously untruthful, unreliable and exhibit a low cunning which often deceives those not familiar with handling individuals of that type. Curiously enough they are exceedingly critical of others and quick to notice their shortcomings. Sexual perversions and immoral conduct are only too common. Prostitution, as has already been shown, is one of the most common failings of the female delinquent. An interesting but superficial knowledge of legal matters is noted very frequently and paraded with a remarkable degree of egotism which is difficult to understand. It is comparatively an infrequent occurrence for a prisoner to admit that he is guilty of the crime of which he has already been convicted by a court. Only a few years since, a prisoner at Sing Sing wrote the Governor of New York suggesting that his release was indicated as a moral procedure for the good of the institution, as he was convinced from information obtained from others that he was the only guilty man in the establishment. The habitual criminal takes little, if any, interest in his own relatives or family except when he is in confinement, and feels no home ties. There is a curious lack of appreciation for the gravity of his own offense and he always complains of a "frame up" and asserts that he has not had a square deal. Homicides even are always explained in an attempt to show that they were justifiable or unavoidable. The most vicious of assaults are often committed on their fellow prisoners without any provocation of consequence. Experience shows that as a rule they are incapable of any sustained effort and accomplish little or nothing when left to themselves. Tendencies to crime show not only a marked suggestibility but a degree of impulsiveness and a lack of self control which is highly significant.
Another type of institution for this special group of cases is strongly indicated. They should be held under an indeterminate sentence and in some instances committed for life. As a result of hereditary defects, arrested mental development, ignorance and vicious tendencies this class furnishes the prisons with our most dangerous criminals. They should receive separate care, with an opportunity for a special education adapted to their individual needs. The defective classes have for centuries been held criminally responsible and have filled our prisons with incorrigibles and recidivists. Modern civilization should place at our disposal some means for remedying this situation other than mere punishment for the possession of an intellectual endowment for which these individuals are in no way responsible. The ends of justice can be served and the protection of the public assured at the same time by a form of medical treatment for the defective delinquent which will look forward to his ultimate restoration to society rather than a form of punishment which accomplishes nothing.
CHAPTER XI
THE PSYCHIATRY OF THE WAR
The psychiatry of the late war is of unusual interest from various points of view. Never before have mental diseases or defects been looked upon as military problems worthy of any special attention either in times of war or peace. It is true that the United States government has maintained a hospital for the treatment of such conditions at Washington for many years, and medical officers from the army and navy have been sent to that institution for instruction, from time to time. No adequate provision has been made, however, in previous wars for the special care or observation of the psychoses or neuroses, nor has any great consideration been given to a determination of the mental status of recruits. It is, of course, equally true that modern military methods have brought about different conditions and given rise to new problems. In 1917 and 1918 definite psychiatric organizations were established by the United States army for the first time. The services of specialists in mental diseases were utilized extensively and they were ultimately assigned to practically all of the large hospitals. Division consultants were soon found necessary and the active cooperation of practically every psychiatrist available in the country was required before the armistice was declared.
This was directly due to the fact that for the first time in history one of the most important problems, with which the military authorities had to deal, was the question of mental diseases and defects. For purposes of comparison and the intelligent consideration of this important subject, the incidence of mental diseases in the army in the past is of considerable interest. The rate in enlisted men, as shown by the Surgeon General's reports, varied from 1.08 per thousand in 1898 to 1.73 in 1911, and was 2.72 in 1900, the only year in which it went above two. In 1912, 1913, 1914 and 1915, when defective mental development, constitutional psychopathic states, hypochondriasis and nostalgia were included in the reports the rates per thousand were respectively 3.45, 3.44, 4.18 and 3.82. The frequency of psychoses was higher in the men serving in the Philippines—2.07 in 1898, 2.79 in 1900, 1.45 in 1905 and 2.01 in 1911.
The ratio of mental diseases in the American and English armies has been higher for many years than in the French, Italian, Russian and German forces. Universal military service is supposed to have been the factor producing this difference, the larger establishments naturally more nearly representing the normal insanity rate of the country. From May 1, 1861, to June 30, 1866, in other words, during the civil war period, there were 198,849 discharges for disability from the United States army.[85] Of this number 819 men were discharged on account of insanity, 3,872 for epilepsy and 2,838 for various forms of "paralysis." Based on the mean annual strength of the army, this represented a rate of .34 per thousand for insanity, 1.6 for epilepsy and 1.17 for paralysis. Based on the total number of discharges alone, it represented a rate of 6.0 per thousand for insanity, 20.8 for paralysis, and 28.3 for epilepsy or a rate for the three combined of 55.1 per thousand. These statistics are for white soldiers only. The rate for colored troops, based on the total discharges, was seven per thousand for insanity, 14.3 for paralysis and thirty-six for epilepsy. No information whatever is available as to what the term paralysis includes in these reports. The rate per thousand in the United States army, as has been shown, increased from approximately one in 1898 to three in 1901, during the Spanish war, Philippine insurrection, etc., and dropped back to one again in 1903. Weygandt,[86] who made a study of war neuroses and psychoses in 1904, gives the insanity rate per thousand of the German army during the Franco-Prussian war as .54, the American troops during the Spanish war as 2.7, the British army during the Boer war as 2.6, the Russian army during the Japanese war as 2.0, and the Bulgarian troops during the Balkan campaign .33. The German expeditionary corps engaged in Southwestern Africa reported 4.95 per thousand and a rate of 8.28 including epilepsy and hysteria.
The first attempt ever made to provide special care for mental diseases in the field was during the Russo-Japanese war. A hospital set aside for this purpose by the Russian army at Harbin treated between fifteen hundred and two thousand men in 1905 and 1906. It has, however, never been claimed that all of the mental cases reached that place. Of 1,310 admissions the following conditions were represented[87]:—epileptic psychoses, 22.5 per cent; alcoholic forms, 19.5 per cent; dementia praecox, ten per cent; confused states, nine per cent; hysterical psychoses, 7.7 per cent; general paresis, 5.6 per cent; toxic conditions, 4.8 per cent; manic-depressive psychoses, four per cent; degenerative types, 3.5 per cent; traumatic psychoses, 3.2 per cent; and organic brain diseases, 2.9 per cent. It is interesting to note that Steida, who analyzed the statistics of the Russo-Japanese war in 1906, reached the conclusion that a psychic trauma alone was not a sufficient cause for the development of a neurosis. He attached an equal importance to prolonged physical exertion, deprivation, loss of sleep, hunger and thirst, etc. The most common disturbances following battles were found to be hysterical excitements and confused states.
As soon as the examination of men for military service was undertaken in this country in 1917 it became apparent that one of the most frequent causes of rejection was either mental disease or deficiency. The second report of the Provost Marshal General to the Secretary of War in 1919[88] showed that of all rejections during the first year of mobilization, twenty-two per cent were due to physical defects which would interfere with duty (defects in bones, and joints, flat foot, hernia, etc.), fifteen per cent were on account of imperfections of the sense organs, thirteen per cent were for defects in the cardiovascular system and about twelve per cent were due to nervous or mental diseases. The inspection at camps following the physical examination of the first million men mobilized resulted in a rejection of nine per cent on account of nervous or mental diseases. Of all causes for rejections from the army up to February 1, 1919, according to Bailey,[89] mental and nervous diseases ranked fourth numerically. The "neuropsychiatric" causes were:—psychoses, eleven per cent; neuroses, fifteen per cent; epilepsy, nine per cent; organic nervous diseases or injuries, eighteen per cent; mental defects, thirty-two per cent, and constitutional psychopathic states, nine per cent; a total of 67,417 cases.