Lectures on clinical psychiatry / by Emil Kraepelin ; revised and edited by Thomas Johnstone.

  • Kraepelin, Emil, 1856-1926.
Date:
1906
    We meet with just the same difficulties in reporting on the case of a farmer, aged sixty-four, who has given full employ- ment to both magistrates and doctors for nearly twenty years. Again and again the question was raised whether they had to deal with a case of mental disease or with an ill-conditioned character, and the answer given has been different every time. The patient belongs to a very degenerate family. His father was insane, and ended his life by suicide, and one of his father's brothers was peculiar, very avaricious, and a general laughing- stock. His mother was temporarily insane, and died of a " stroke." One of his sisters was insane after a confinement, and a brother, who is feeble-minded, is in an asylum. Until his forty-second year the patient had only been convicted of a few unimportant offences, but at that time he came into possession of considerable means, inherited from his father, and then began a series of lawsuits, far too many to be enumer- ated here, which have left him completely ruined. The official reports we have seen, which cannot yet be considered complete, refer to 81 prosecutions on criminal charges, 41 informations laid by him against others, and 110 civil lawsuits. He was convicted in 65 of the criminal cases, but on most of these occasions he was only sentenced to small fines, as the offences which accumulated from his forty-fifth year onwards were, without exception, very trivial. Generally there was a question of trespass. He drove over other people's land, ploughed beyond the limits of his own fields, let his cows graze on his neighbour's clover, and cut into his neighbour's hay in mowing. Several times he reaped the crops he had sold stand- ing, after having quarrelled with the buyer, and once, under similar circumstances, he tore up a field full of potatoes. A second group of offences consists of petty larceny and frauds. He appropriated articles that had been left unwatched, and used them himself, stole his neighbour's eggs under the pretext that his own fowls had laid astray, brought tools away with him when he was discharged from prison, and put several heavy chains into the balance when he sold his hay by weight. He was also guilty two or three times of signing other people's nam^s to letters and petitions. He made a number of false and slanderous accusations, principally against the rural police- man, who had so often reported him, but also against all kinds of people with whom he happened to have quarrelled. He
    charged the witnesses who did not support him with perjury, a neighbour who had accused him of stealing grapes with forgery, and two other neighbours with arson, one of these having burnt a heap of rotten forage which the patient had dishonestly cut on his land. He accused his brother's guardian of defalcations, and one of his enemies of bribery, disorderly and indecent behaviour, and living with a mistress. In a single year he brought twenty-two charges of this kind, and fifteen times he repeated charges previously made, or appealed to the Public Prosecutor or the Ministry of Justice. He charged the burgo- master and the town clerk with indecent assault, declaring that they had made immoral advances to his wife in the town- hall. He also brought a charge of manslaughter against a neighbour, who, he said, had undoubtedly maltreated him in such a way as almost to cause his death. Two years earlier he had brought a charge of maltreating his wife in an exactly similar form. All of these numerous charges depended on witnesses who generally knew nothing about the affair, or else contradicted the accusation; but in spite of the absence of any prospect of success, they were carried through all the courts of appeal. Sometimes they referred to events long past ; thus, the patient sued a tanner for 5 marks, the value of a calf-skin said to have been missing eight or ten years previously, accused him of perjury when he denied the debt, and left no legal pro- ceedings untried. In connection with these events, which show that he was at perpetual war with those around him, the patient was convicted on many occasions of grossly offensive conduct, of using threatening language, and of disturbance of domestic peace. He dirtied his neighbours' doorsteps in the night, smeared filth on the latches, posted up offensive notices, smashed the lock of a door, and threatened personal violence. Lastly, he broke the police regulations in every conceivable way. He was absent from fire-drill, fastened dirty tubes to the public foun- tain in order to fill up his barrel of liquid manure, fraudulently evaded the payment of tobacco dues and dog-tax, failed to make a return of the number of his labourers, opened a chalk-pit without permission, drove through the village in defiance of the bye-laws, and left his manure-cart standing in front of his neighbours' doors. The patient's appearances in court in connection with his
    civil obligations were almost as numerous and varied. His pecuniary relations to his brother in the asylum were a specially abundant source of trouble. Every attempt of his brother's guardians to compel him to perform his duties led to a long chain of actions, which were carried on with the greatest obsti- nacy, and always absorbed large sums of money. It was useless to make any agreement with the patient, as he never kept to it, but commenced fresh actions, or made it necessary to bring such against him. His butcher and baker, his doctor and chemist, were also obliged to sue him, for he refused to pay them on the most frivolous pretexts. He declined to pay for a cow, more than a year after he had bought her, on the ground that she had not been worth the money, although he had sold her again in the meanwhile, and had had a calf from her. These perpetual lawsuits, which often swallowed up a great part of the property in dispute, to say nothing of loss of time spent in writing out documents and attending at inquiries and on court days, led to the patient's continual impoverish- ment, until at last he was obliged to seek the poorhouse. His wife sought for a long time to restrain him from his senseless litigation, and finally tried to help him by artfully causing the remains of his property to be transferred to her. But eventually she became ill herself, apparently with a real queru- lous delusion, and then, either alone or in association with her husband, who followed her blindly, she began a fresh series of lawsuits on her own account, connected with the transference of the property, and carried them on with passionate eagerness, until they were brought to an end by her being certified as insane. Our patient himself had long been regarded by his neighbours as " very spiteful and litigious," a man who could never acquiesce in law and order, and cared for nothing but quairelling and litigation. His wife said more than ten years ago that he was very nervous. He slept badly, got up at one or two o'clock every morning and cooked himself food, wandered about rest- lessly, bought things he could not use, and had spent about 6,000 marks unnecessarily. " When he does^anything wrong he has no idea that he will be punished for it. When called upon to pay a fine, he seems very much upset. He cannot under- stand at all why he should be punished, and complains that he is persecuted by everyone." It was thought necessary to have 20
    him certified as insane, but the doctois called in could not agree. One declared that the patient was suffering from periodically recurrent states of semi-consciousness, and another that he was not really ill, but cunning and artful. He himself alleged in one of his petitions, as an " important reason," that he was mentally irresponsible, and so could not be punished. He re- peated the plea of mental derangement so often, that he was ordered to be examined at this hospital seven yeais ago, when he had to be brought here by force. The police surgeon thought that he was unwilling to come because he was a malingerer and was afraid of being found out. The report on this examination left it an open question whether he was insane in the sense required by the criminal law or not, and he began his old disputes afresh. Now at last the determination to have him certified, which had again elicited a number of contradictory opinions, has led to his being once more under observation in our hospital. Our patient, an ill-nourished man of medium height, who looks very old for his years, has listened to our account of all this without any sign of real interest. His face is wrinkled, and his mouth is almost devoid of teeth. His large ears stand out far from his head, and the lobes are soldered. His right pupil is more dilated than the left, and his hearing is rather bad. The arteries in his arms and temples are corrugated and hard. These and a double inguinal hernia are the only physical changes to be seen. The patient's sleep appears to be normal, and his weight has increased since he was here before. li we diaw the patient himself into conversation, we find that he is collected, clear and methodical in his ideas, but he has to be pressed to answer our questions adequately. He seems to be listless and morose, and gives us brief, evasive, and indefinite replies, but gradually he begins to show more interest. We find that he has a very good recollection of his numerous appearances in court, and often defends himself in the very words he used at the time. It is true that he repeatedly declares that he cannot remember anything about some particular occurrence, because his memory has grown so bad, saying, " Often when anything happens, I can't remember it properly," but it can generally be shown by a careful use of indirect questioning that he knows quite well what we are referring to. On the other hand, his knowledge of important public events, and of every-
    thing lying outside the narrowest circle of a countryman's interests, is very small, and he has difficulty in doing arithmetic, although he generally finds the correct answers to the sums. He says that he voted at elections " as the parson arranged." He maintains that he became involved in his legal difficulties and came into collision with the police by no fault of his own. " I have never done anything wrong." It was always other people who were to blame. It was all " lies and nonsense "; the court was misinformed, and false accusations were brought against him. " What extraordinary things are said about one !" He does not know at all why he always got mixed up with such unlucky affairs ; people were unfriendly, and " one can't get one's rights." He really could not put up with being punished when he was not to blame ; but his complaints were rejected because the false witnesses always made everything seem different. Things were not properly inquired into, and the witnesses were not pixt on their oath. "If the gentlemen of the court had gone themselves, it would have been different." He made all those accusations because he could not bear to see a wrong done, but sometimes he was inconsiderate. One is bound to believe people when what they have said has all been true before, or one would not be able to believe the parson in the piilpit, and one is bound to take notice of it when one hears of anything wrong. If he is driven into a corner, and shown the obvious falsehood of some of the charges, he sighs and says : " If only I could escape from this world—if only the Lord God would take me from my troubles !" People may believe what they like, and he would rather they put an end to him at once. All he wishes for now is that the Grand Duke would " try his cause "; he would be contented with his decision. He is not mad, bi;t only often low-spirited and depressed. He would like to have his house back, and then go on foot to Rome and Pales- tine. If he made it a plea that he was always represented as being insane, that was because a man must defend himself as best he can. Since the patient has been here he has not had much to do with those around him, and has talked and read very little of his own accord. He has often gazed from the window apathet- ically for hours together. Our patient's very grave heredity at once suggests the sus- picion that this is a case of morbid personality, and the suspicion 20—2