Studies in Forensic Psychiatry - Bernard Glueck (grave mercy .TXT) 📗

at once disappear. The difference in the symptomatology of the two attacks serves to illustrate how difficult it is to positively state what relation these disorders have to hysteria. Here we have an individual whose past life fails to indicate anything which may be taken as of an hysterical character. He develops a psychogenetic disorder in consequence of his crime, the symptomatology of which shows little, if anything, of an hysterical nature. In due course of time he gets well, and after having thrust upon him a life sentence, again returns to us with a mental disorder, the chief feature of which is a functional hemiplegia. There is very little doubt that by studying a cross-section of his second attack we could easily place it under the group of hysteria. Considering, however, the history of the case in toto, we would have to proceed rather cautiously in judging of the hysterical element thereof.

Case III.—G. W. W., white, male, aged 26 years, whose hereditary history cannot be definitely determined. It appears that mother was a janitress in Boston, and had several children by various fathers. Patient grew up in an orphanage, and worked on farm until age of 18, when he drifted to Denver, Colorado, and enlisted in the U. S. Navy. He served one enlistment with a good record, was a good sailor, and got along well in every respect. He reënlisted the second time about the middle of 1909, when at the instigation of a fellow sailor he deserted from the Navy in company with the latter. On August 20, 1910, they held up the captain of a ship with the intention of obtaining some money which was stored on board the vessel. In the encounter the captain was killed by the patient’s companion, who made his escape, while the patient was apprehended and held on a charge of murder. On August 24th, he was placed in jail at Oakland, California. From the beginning he was regarded by the jail officials as rather silly and defective. He did not appear to be very much interested in his case, and never spoke of his own initiative to his attorney about it. On May 8, 1911, he was seen for the first time by a psychiatrist. He was then found to be very distractible and inattentive, seemed suspicious and excited and assumed stiff attitudes. He was well oriented, and recognized that he was on trial for murder. It might be mentioned here that although the jail officials apparently noted from the first that the patient was not right, the legal proceedings were continued, and it was only on the 4th or 5th day of his trial that his conduct became such as to strongly suggest that he was insane. A psychiatrist was then called in and he pronounced the patient insane, whereupon the proceedings were stopped at this juncture. Examination at that time revealed the following:—General sensation markedly reduced; hypalgesia, he allowed needles to be stuck into his tongue without flinching; walked in a stiff and stooping fashion; no Romberg; moderate vaso-motor stasis, with bluish, cold hands. Gait uncharacteristic. Eyes reacted to light, directly and consensually, and to accommodation. Patellar, Achilles and arm reflexes markedly exaggerated and equal. No foot clonus, no Babinski; abdominal reflexes present, cremasteric not elicited; catalepsy not always present.

Mental Examination:—Attitude was variable, but was distinctly that of one in a stupor. Arms, hands and legs, placed in uncomfortable positions, would remain fixed indefinitely, i.e., so observed from 20 to 30 minutes. Did not resent liberties taken with him; smiled in a silly fashion at each person. Orientation perfect; no insight; hallucinations and delusions could not be elicited. Attention could only be gained with great difficulty, and held for a very short time. Retardation was present; movements were slow and stiff. When stimulated, however, he responded promptly and had no retardation. Speech and writing showed nothing characteristic.

May 11:—Flexibilitas cerea more marked; mutism; retention of saliva; eats food voluntarily; bowels require frequent attention.

May 20:—Requires spoon-feeding; sleeps well; remains always in bed in stiff attitudes.

June 1:—For three or four days refused food, except for one or two meals daily. At times suddenly surprises attendants by sensible remarks, as: Another patient said, “That is G. W. W.,” and patient promptly replied, “No, it is Rip Van Winkle.” Negativistic signs more marked. Knows physician when eyes are pushed open. At times tries to whistle.

June 13:—For past week has been noisy and excited. When he hears dishes rattle, yells “Chow-chow” for a long time. Continued hot bath for one hour always relieves this excitement. Physical signs negative; Wassermann negative; blood and urinary analysis negative.

June 18:—Admitted to the Government Hospital for the Insane. The Marshal who accompanied the patient from California to this institution states that the patient was resistive and negativistic; that he assumed various constrained attitudes; was untidy, mute, and refused food. All these tendencies were markedly influenced, however, by positive requests of the Marshal. When told that he would be chastised if he did not give up his untidy habits, these disappeared, etc. On admission to the Government Hospital for the Insane the patient had to be carried into the ward, as he refused to walk. He was mute, negativistic, and assumed various uncomfortable and constrained attitudes. Every now and then he would snap at those who handled him, and this would be accompanied by a growl. He was very resistive to the taking of a bath, and suddenly snapped at the attendants who cared for him. When reprimanded, however, by the Supervisor, and told that he would have to take the bath, he quietly underwent the procedure.

Physical Examination:—Pupils widely dilated. Face somewhat distorted. Pupillary reflexes normal; although limbs would remain in a fixed attitude when so placed, he did not evidence the typical flexibilitas cerea. It seems as though he anticipated the passive movements, and there was present a certain amount of voluntary intent. All superficial reflexes active; winced when pricked with a pin but there was a decided hypalgesia present. He refused food; was mute, and apparently oblivious of everything about him. This, however, was only apparently so, as he showed by various acts that he was more or less aware of his surroundings. For instance, during the examination he suddenly snapped at the examiner, and upon the latter’s discomfiture he emitted a momentary giggle. When feeding-tube was placed in his nose, preparatory to feeding, he jumped up and said, “I’ll drink it,” and drank the entire contents of the pitcher. While some parts of his body remained absolutely fixed, restrained and immovable, his face was constantly undergoing various grimacing motions, accompanied now and then by the snapping of his jaws and a growl. During the following several nights he was very noisy, excitable, singing and shouting throughout the night. Mental content could not be determined at this date.

June 28, 1911:—He remains in same apparent stuporous and catatonic attitude. For past few days has exhibited various childish and silly acts of a meaningless and monotonous nature. Still mute except for an occasional growl. Became very untidy today, but when reprimanded and told he must use the toilet he did so.

July 1, 1911:—Patient has been very noisy on several occasions in the past few days, but always becomes quiet when requested to do so. Continues negativistic, stuporous and attitudinizing. Today he was overheard saying: “I am a monkey; want to go out in the yard and sit on the benches; there was no plea of insanity; who are those boys? Come in, boys; water, won’t drink it because there is poison in it, it looks good, so try it. Don’t believe there is anything in it.” He persevered in repeating these phrases.

July 2:—Sang all morning in an undertone. Would stop singing and recommence his facial grimaces when anyone entered his room.

July 3:—For the first time since admission patient answered examiner to questions.

Q. “What is your name?”

A. “George Washington.”

Q. “How old are you.”

A. “36.”

Q. “When born?”

A. “1884.”

Q. “Occupation?”

A. “Farmer.”

Q. “Where born?”

A. “Around Boston.”

Q. “What day is this?”

A. “Someone says Tuesday.”

Q. “What date?”

A. “June 17, 1911.”

Q. “How long have you been here?”

A. “I cannot tell you.”

Q. “What is the name of this place?”

A. “U. S. Hospital.”

Q. “Who brought you here?”

A. “Can’t tell you, he looks like a monkey.”

Q. “How long did it take you to get here?”

A. “One night and twenty-four hours.”

Q. “When did you come here?”

A. “I cannot tell you when I did come here.”

Q. “Don’t you really know the name of this place?”

A. “Well, sailors in the Navy call it the ‘Red House.’”

Q. “Where is it located?”

A. “Washington, D.C.”

Q. “What sort of a place is it?”

A. “Why, it’s as good as any place else.”

Q. “Who are these people about you?”

A. “They might be soldiers; what are they out there for?”

Q. “Is there anything wrong with them?”

A. “How should I know?”

Q. “Are any of them insane?”

A. “Darn’d if I know.”

Q. “How do you feel?”

A. “How did I get cured of my headache? I’ll stick a pitchfork through you, and if a pitchfork goes through you, it will go through me too.”

Q. “Are you sick?”

A. “I was sick; had a pain in the head.”

Q. “How do you feel now?”

A. “Oh, pretty good.”

Q. “Is there anything wrong with your mind?”

A. “I don’t know, I can’t tell you.”

Q. “Do you hear any strange noises or voices?”

A. “Can you go over to that tree? Sounds like a baby squealing; it’s the man that choked the baby.”

Q. “Do you ever see strange things?”

A. “Did I ever see strange things? I might read about them in the magazine.”

Q. “Do you ever hear voices?”

A. “I hear voices say to you; ‘You are not guilty.’”

Q. “How much money are you worth?”

A. “$100; I’ll give it you for my life.”

As will be seen from the foregoing stenogram, the patient is only partially oriented, perhaps more so than he shows, because of his tendency to answer questions in a sort of careless manner. There is a slight suggestion of “by speaking” (Vorbeireden). The stenogram also suggests the possibility of the existence of fallacious sense perceptions. Of the utmost importance, however, for our consideration, is the fact that the occurrence which brought about the mental breakdown plays an important rôle in the consciousness of the patient. Amid what may be considered an almost total oblivion to his immediate environment, he hears the voices tell the examiner that he is not guilty, he would give the $100 which he possesses for his life. These are unmistakable signs of the psychogenetic nature of the disorder.

July 31:—Patient is well oriented, talks in a retarded manner; questions are answered for the most part correctly; occasionally, only nearly correct. His memory is good for remote events, but very much clouded for events which have transpired since the commission of the crime. Partial insight is present. He realizes that there must have been something wrong with him. Emotionally not deteriorated. Refuses to discuss his crime, saying it makes him feel bad; talks in a childish, affected tone of voice, and undergoes various grimacing movements; gives frequent evidence of being fully aware of occurrences in his environment; talks and eats voluntarily and is tidy in habits. Occasionally laughs in a silly, affected manner. Flexibilitas cerea and catalepsy entirely disappeared; gained considerably in weight; continues to show marked tendency to be influenced by occurrences in his environment. In general, shows a decided improvement in his condition.

We are dealing here with an individual whose past career is uneventful, as far as is known. He is charged with murder, and upon being tried for this develops a mental disorder. The symptomatology of his psychosis could easily be mistaken for that of catatonic præcox, and, as a matter of fact, had been so diagnosed by the first observer. In studying the case more thoroughly, however, it becomes unmistakably evident that we are not dealing here with a case of catatonia. In the first place, the immediate relation