Autor: Uszkiewiczowa, Lidia - Katalog OPAC zbiorów

Skocz do pozycji: 1.

Tytuł:: Orzecznictwo sądowo-psychiatryczne w świetle 4200 ekspertyz szpitalnych
Results of forensic-psychiatric examinations of 4200 offenders
Autorzy:: Uszkiewiczowa, Lidia
Powiązania:: https://bibliotekanauki.pl/articles/699188.pdf
Data publikacji:: 1960
Wydawca:: Polska Akademia Nauk. Instytut Nauk Prawnych PAN
Tematy:: orzecznictwo sądowo-psychiatryczne
ekspertyzy szpitalne
sprawy karne
obserwacja kliniczna
szpital psychiatryczny
psychopatia
alkoholizm
niedorozwój umysłowy
schizofrenia
forensic-psychiatric examinations
mental hospitals reports
criminal cases
delinquency
offences
psychiatric hospital
psychopathy
mental deficiency
alcoholism
schizophrenia
Opis:: The present contribution discusses the results of 4200 forensic-psychiatric reports given, in the years 1953 to 1957, by twenty-one mental hospitals and the Department of Forensic Psychiatry of the Psychoneurological Institute, where copies of such reports, given by all the major mental hospitals in Poland, are collected. The present contribution does not take into consideration 300 reports in which no symptoms of a disease have been found with the subjects investigated, nor yet any mentally abnormal states, as well as 460 reports concerning reactive psychoses and 80 cases of simulation which arose only after the arrest of the investigated. (Cases of reactive psychoses and simulation will be dealt with separately, because of the altogether peculiar problems involved). Even though the leaving out of the account of the psychiatric examinations carried out in the Public Prosecutors’ Offices and the Courts of Law does not allow us to draw conclusions with regard to all those offenders suffering from mental disorders who have been submitted to examination, nevertheless, the large number of hospital reports available would seem to constitute valuable psychopathological and criminological material. 1. In investigating the cases sent by the Public Prosecutors’ Offices and the Courts to mental hospitals for psychiatric observation, we find, on the basis of available material, that the percentage of psychoses – setting aside reactive psychoses – is small, as it does not exceed 22 per cent. Three items: psychopathy, mental deficiency (most frequently a light feeble-mindedness or moronity) and alcoholism jointly account for a total of 50.8 per cent of the cases, and if, over and above that, we take into consideration post-traumatic mental disorders, epilepsy, post-encephalitic disorders and such like cases, it will appear that as many as over three-fourths of the reports given concern non-psychotic states. Psychopathy accounts for 27.4 per cent of the cases, alcoholism and mental deficiency for 15.8 per cent each, post-traumatic disorders for 5.9 per cent, epilepsy for 4.7 per cent, and post-encephalitic disorders for 1.5 per cent. In the material under investigation cases of psychopathy amount, in reality, to more than 27.4 per cent, since cases of reactive psychoses and simulation, in which psychopaths figure extremely often, have been left out of the account. Similarly, there are probably more post-encephalitic states, which, having failed to be properly diagnosed, figure in cases which come under other heads, because of the lack of reliable interviews and the negative result of the neurological examination (in particular, in the mental deficiency and psychopathy groups). Cases of alcoholism, too, are less numerously represented in the material under investigation than would seem to result from the diagnoses contained in the reports. There can subsist no doubt that, apart from cases where the diagnosis reads ,,chronic (or else habitual) alcoholism", we also meet with alcoholism with a great many of such of the investigated with whom other pathological states have been diagnosed, and where alcoholism merely constitutes an additional factor, as a complication of other mental disorders. Altogether, the percentage of alcohol addicts amounts to at least 28. Among psychoses, schizophrenia is the one most numerously represented (510 cases). Only 29 delinquents suffered from manic-depressive psychosis, 62 from general paralysis, 30 – from involutional psychosis, 28 - from senile dementia. There were 19 cases of delusional psychosis, and 14 cases of paranoia. The number of cases with cerebral arteriosclerosis was 49, and that of cases of cerebral syphilis - only 20. In 44 cases it was a matter of twilight states with non-epileptics; here belong 30 cases of pathological drunkenness, 7 cases of pathological affect, 3 cases of ,,short-circuiting" (the so-called „Kurzschlusshandlungen” in German), and 4 cases of twilight states with an obscure etiology. 87.1 per cent of the reports concern men, 12.9 per cent - women. For every 100 men investigated there were only 14.9 women, while in the 1955 judicial statistics there were as many as 30 convicted women to every 100 convicted men. Cases of psychopathy, mental deficiency and schizophrenia constitute 61.3 per cent of the total of reports concerning women, while with men the above three items only amounted to 63.8 per cent after cases of alcoholism were added to them. Women are relatively most numerously represented in involutional disorders and manic-depressive psychosis. 2. When we examine the data concerning delinquency, it is obvious that it is the perpetrators of manslaughter, sexual offences and arson that are particularly numerously represented in the judicial psychiatric material. The most common offences against property, which constitute 33 per cent of the total number of offences in the material under investigation, reach the highest percentages in those cases which are not psychoses. On the other hand, among the offences perpetrated by persons suffering from psychoses there are relatively more offences against life and health, and, in particular, of manslaughter. Manslaughter amounts to 14 per cent of the offences committed by the persons investigated suffering from involutional psychosis, to 12.2 per cent of those committed by sufferers from schizophrenia, to 11.1 per cent of those committed by sufferers from paranoia, to 10 per cent, with sufferers from senile dementia, while with psychopaths the figure is only 5.7 and with oligophrenics - 4.7. Altogether, there were 288 cases of manslaughter or murder in the material investigated, and of these 77.4 per cent were divided between cases of psychopathy (67 cases), schizophrenia (67 cases), alcoholism (51 cases), and mental deficiency (28 cases). Among the 179 cases of sexual offences the bulk were cases of misconduct with persons under 15 years of age (93 cases), there were 43 cases of rape, 21 cases of incest, 12 cases of exhibitionist acts. Nearly 70 per cent of the sexual offences have been committed by psychopaths (55), oligophrenics (41) and alcohol addicts (28). On the other hand, the relatively highest percentage of such offences is to be met with those suffering from senile dementia, cerebral arteriosclerosis, and with mental deficiency. As far as arson is concerned, which in the material under investigation amounted to 3.3 per cent of the total number of offences, percentages higher than average ones are to be met with in cases of involutional psychosis, senile dementia, schizophrenia and mental deficiency. Out of a total number of 146 cases of arson, 53.4 per cent were accounted for by schizophrenia (40) and mental deficiency (38). With psychopaths and alcoholics comprised by the material under investigation cases of arson are extremely rare. Examining the delinquency of 158 epileptics, we establish that both the percentage of manslaughter and the number of cases of arson are small. What is worth while noting beside that is the fact that only in 24 cases the offence was perpetrated in a twilight state. The data concerning the delinquency of 510 schizophrenics bear witness to the fact that it was only a mere 8 per cent of the investigated that committed the offence during the first year of their illness, while the majority of cases the latter has been going on for above three years. When we analyze the 67 cases of manslaughter we find that it was only in two cases that the manslaughter was committed in the initial stage of the disease and constituted, as it were, the first visible sign of the schizophrenic process. In delusional psychoses cases of manslaughter were frequent, differently from cases of paranoia. In the few (29) cases of manic-depressive psychosis only one offence was committed in the depressive phase, white all the others were committed in the maniac phase or else in the hypomanic state. Deserving our attention is the lack of any more serious offences against life and health in this group. In the 30 cases of involutional psychosis more than one half of the offences consisted of those against life and health. Among the offences committed by the 49 persons with symptoms of cerebral arteriosclerosis, one-third consisted of offences of a serious character, while with the 25 patients suffering from senile dementia as many as one-half of the offences belonged to the category of serious offences. The delinquency of the 62 sufferers from general paralysis is almost exclusively reduced to offences of small importance of similar character as were the offences committed by the 20 sufferers from cerebral syphilis. In the 44 cases of twilight states (pathological drunkenness, pathological affect, and others) still 50 per cent of the offences consist of offences against life and health; 18 people fell victim to manslaughter. 3. The Polish Criminal Code, in force since 1932, contains provisions concerning, both in cases with mentally abnormal states, a state of irresponsibility and of diminished responsibility. A state of irresponsibility occurs when, at the time of committing the offence, the accused did not understand the significance of the deed he was perpetrating, or else was unable to direct his conduct because of psychosis, mental deficiency or other psychical disorders. A diminished responsibility occurs when, because of one of the reasons mentioned above, the ability of the accused to grasp the significance of the offence committed by him, and to direct his conduct was considerably limited. With regard to such and offender the Court may apply an extraordinarily mitigated penalty, while with regard to an offender who has been declared irresponsible, of course, no penalty at all may be applied. The offenders declared irresponsible are, by virtue of the Court's decision, transferred to a general mental hospital, if their staying at large could be dangerous for the legal order. They cannot be released from the hospital by the Court earlier than after the lapse of one year. An offender with regard to whom a diminished responsibility has been decreed and who is dangerous to the legal order may also be placed in a mental hospital (he, too, can be released from there by the Court not earlier than after the lapse of one year at the least). If the Court has sentenced such an offender to serve a term of imprisonment, the question of whether or not the penalty decreed is to be served is decided by the Court after the offender's release from the mental hospital. In cases of psychosis, forensic psychiatrists always decree irresponsibility. In cases of mental deficiency their decree depends on the degree of such deficiency, while in the cases, most frequent in judicial practice, of mild subnormality (morons, debils) – also on the, category of the offence which has been committed. Psychopaths are, in principle, considered to be fully responsible. Altogether, out of a total of 3900 delinquents examined 24.7 per cent of the cases have been pronounced by experts to be irresponsible, 23.1 per cent of the cases – to have a diminished responsibility, while 50.7 per cent of the offenders have been declared to be fully responsible. 4. As far as experts' opinions are concerned with regard to the application of internment in mental hospitals of offenders pronounced to be dangerous for the legal order, as well as irresponsible, out of a total number of 946 offenders declared irresponsible, a mere 34 per cent have been pronounced to be dangerous. Moreover, in 31 per cent of the cases, experts have pronounced for the necessity of hospital treatment under ordinary circumstances. Finally, 35 per cent of the offenders pronounced to be irresponsible have been described as not standing in need of any hospital treatment. A diminished responsibility has been decreed by the experts in a total of 855 cases, but only 6.4 per cent of the latter number have been pronounced to be dangerous to the legal order and to stand in need of internment in a mental hospital. Apart from the above, only in 10 per cent of the cases, experts have pronounced in favor of the need for hospital treatment. In the remaining 83.5 per cent of the cases the experts have confined themselves to stating that the responsibility of the offenders in question was diminished which, in result, comes merely to a possibility of an extraordinary mitigation of the penalty being decreed by the law-court. It is evident from the analysis of the judicial sentences which we have just carried out that experts a[ too unfrequently declare in favor of the need of applying security measures. The result is an irrational punitive policy with regard to such offenders who ought to be approached first and foremost, from a psychiatric point of view. The Criminal Code provisions concerning security measures are obsolete and demand essential alterations, which can only be done by means of codification. Quite independently of the need for extending the network of ordinary mental hospitals, there also exists a necessity of creating a special type of establishments, of a psychiatric-cum-penitentiary character, for a certain category of offenders who exhibit abnormal mental peculiarities and tendencies to recidivism. Equally needed is the establishing of treatment homes for offenders who are alcohol addicts. As it ensues clearly from experiments made in various countries, the application of ordinary penalties to delinquents who require a special treatment from a psychiatric point of view is altogether inefficacious.
Źródło:: Archiwum Kryminologii; 1960, I; 297-359
0066-6890
2719-4280
Pojawia się w:: Archiwum Kryminologii
Dostawca treści:: Biblioteka Nauki

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Tytuł:: Problematyka zaburzeń reaktywnych i symulacji w praktyce sądowo-psychiatrycznej i penitencjarnej
The Problem of Reactive Mental Disorders and of Malingering in Forensic Psychiatrist Practice
Autorzy:: Batawia, Stanisław
Uszkiewiczowa, Lidia
Powiązania:: https://bibliotekanauki.pl/articles/699294.pdf
Data publikacji:: 1964
Wydawca:: Polska Akademia Nauk. Instytut Nauk Prawnych PAN
Tematy:: zaburzenia psychiczne
mental disorders
Opis:: Problems of reactive mental disorders and of the simulation of mental disorders have lately been very poorly represented in both psychiatrist and criminological literature. The present contribution discusses the sources of a considerable number of difficulties which emerge in practice when discussing the question of “Reactive disorder or malingering?”, as well as the errors of diagnosis in diagnosing malingering. The contribution is based on a analysis of material which comprizes three hundred and fifty cases of reactive mental disorders, and ninety-nine cases of malingering (simulation), with the accused; such material has been obtained from the Department of Forensic Psychiatry of the Psychoneurological Institute and from fifteen mental hospitals in Poland, to which prisoners were sent for observation. When making use of the term of “ malingering” , the contents of that notion ought to be narrowed down so as to comprize behaviour of such kind, which consists in an individual who is not mentally ill consciously producing definite psychopathological symptoms. We could not possibly consider to be malingering in the true sense of the word the producing by a mental patient (e.g. one suffering from schizophrenia) of symptoms which are not characteristic of the disorder in question. What is described by the term of sursimulation, even though it contains elements of malingering, essentially differs from true malingering. On the other hand, the view is not correct which reads that we may only then speak of malingering, when the simulating of symptoms of mental disorders makes its appearance with persons who do not exhibit any abnormal traits. Malingering most frequently makes its appearance with prisoners who exhibit symptoms of psychopathy, encephalopathy, mental deficiency, etc. The problem of metasimulation deserves special attention. The fact that at a given moment we have to do with a behaviour which indicates malingering is not by itself evidence that previously, during the period immediately preceding such malingering, reactive disorders did not appear with same prisoner. The symptoms of reactive disorders during the period which preceded the sending of the prisoner to a mental hospital may have become almost entirely extinguished, while their place was taken by an attitude of malingering, greatly reminiscent of the recent symptoms of reactive mental disorders. Besides, in cases of that kind there also arises, as a rule, the question of whether, side by side with elements of malingering, there do not appear feebly marked symptoms of reactive mental disorders, as remnants of the reactive disorders from which the patient had previously been suffering. Neither should another difficulty, which jurisdiction finds in its path, be forgotten. When having to do with an attitude of obvious malingering, one ought to take into consideration the possibility of malingering being gradually transformed into reactive disorders. The mechanism of malingering becomes fixed in the prisoner’s mind, it undergoes automation, and sets into motion a hysterical mechanism, which, in its turn, acts independently, in the way proper to it, owing to which psychogenic disturbances arise. Such a state as that cannot be described as malingering, in spite of the fact that it was simulation that not only constituted the starting-point of the disorders arisen, but had actually provoked, and to some extent moulded, them. An individual in that state no longer exercises any control over the symptoms of reactive disorders which have appeared, he ceases to exercise any mastery over them; the former malingering mechanism has been driven out of his consciousness and has become transformed into a new, and considerably more complicated hysterical mechanism. The cases discussed above may still run a course complicated in another way, namely after the transformation of malingering into reactive disorders certain symptoms of the latter in their turn are subject to undergo, even after the extinction of the disorders, a conscious consolidation through the new manifestation of the malingering mechanism. Therefore in such cases malingering may be observed, not only at the beginning, but also after the recession of the state of reactive disorders, in the form of metasimulation. The mechanism of the arising of reactive disorders is analogous to that of the arising of malingering; at the basis of both the above mechanisms there lie certain common fundamental tendencies. In all probability malingering runs along the very same tracks as hysterical reaction, and mobilizes, through the intermediary of autosuggestion, analogous mechanisms, causing, as it were, the automation of certain attitudes. Malingering individuals, even though at first they control that mechanism and consciously steer it, may lose their control over it. This leads to the cases of a transformation of malingering into reactive mental disorders, discussed above. The knowledge of making use of a mechanism approximating a hysterical one, of producing and fixing certain symptoms which would constitute a good imitation of disorders, is - as is well known - a most difficult thing. This is why long-lasting and consistently carried out malingering is an extremely rare phenomenon. An individual who simulates in such a way must be equipped with peculiar features, in order to be equal to tasks of that kind. Hence the well-know saying that “ one can simulate well only that which is close to the simulating persons’s individuality” (Lassegue), and that “ a good malingerer must be born such” (Braun). Among psychiatrists there prevails, generally speaking, an agreement as to the view that long-lasting and consistent malingering happens, as a rule, only with persons whose personality exhibits clearly pathological features. The data obtained from sixteen mental hospitals for the period of 1953 - 1960 bear witness to the fact that, out of 5,967 male prisoners sent there for psychiatric examination, mental reactive disorders have been found to exist with 711 cases (11.9 per cent.), and malingering of mental disorders in a mere 99 cases (1.6 per cent.). In the case of the 793 women, sent from prisons to mental hospitals for psychiatric examination, reactive disorders were found to exist in 73 cases (9.2 per cent.), and malingering in a mere 7 cases (0.9 per cent). When we analyse the 99 forensic-psychiatric reports which diagnosed malingering, it appears that we may distinguish two different groups of cases among them. The first of them comprizes 70 prisoners,, with whom the diagnosis of mere malingering does not arouse any essentia] diagnostical reservations. On the other hand, in the second group, which comprizes 29 cases, we have to do with 19 cases of undoubted metasimulation, as well as with 19 cases which are doubtful. Doubts arise in connection with the possibility of the co-existence of reactive disorders with simulation (5 cases), as well as with the presence of reactive disorders during the period immediately preceding malingering (3 cases), or finally, because of data which speak in favour rather of reactive disorders than of malingering (11 cases). Thus it is only in seventy cases that the diagnosis of malingering does not arouse any serious doubts; neither should it be forgotten that, at the same time (i.e. during the same seven-and-a-half-year period) as many as 711 cases of reactive mental disorders were observed with prisoners in sixteen mental hospitals. Thus cases of malingering of long duration are an extremely rare phenomenon in forensic psychiatrist practice. For the purpose of establishing how do the data look which concern long-term malingering of mental disorders in prisons, data concerning the number of cases of malingering within the period of one year have been obtained from the psychiatrists employed in two large Warsaw prisons, which are, in principle, destined only for prisoners under investigation. It was found that the number of malingering prisoners amounted, in one prison to nine, and in the other to five. Taking into consideration the number of all the prisoners detained in those prisons in the course of twelve months, the “ co-efficient of malingering” , calculated as per one thousand prisoners, amounts to 1.86 and 0.96 respectively. After a correction has been introduced, because of the possibility of certain prisoners failing to report for examination, that co-efficient should not exceed 2 pro mille.[1] Among the 350 cases of reactive disorders, selected by lot out of the total number of reports with a diagnosis of “ reactive disorder” for the purpose of obtaining a representative sample, metasimulation during the period of clinical observation has been stated to take place in as many as 24.8 per cent, of the cases. When examining the two groups of cases: those of “ pure” malingering and those of metasimulation, we can establish the essential differences which exist between them. Those prisoners with whom no reactive disorders have been found to exist during observation, simulate other symptoms of psychotic disorders than those prisoners, with whom malingering has made its appearance only after the extinction of reactive disorders in hospital. In the group of the seventy “ pure” cases of malingering the most numerously represented is the simulation of memory defects and of mental deficiency, or else of dementia; apart from the above, prisoners also simulate symptoms of conversion hysteria, of hallucination or delusion, as well as, exceptionally, symptoms of stupor. On the other hand, in the group of fifty cases of metasimulation, more than one-half of the total number consisted of prisoners who simulated symptoms of pseudodementia along with elements of puerilism (which were altogether absent from the group of “ pure” simulation). Of cases of con- fabulation with symptoms of pseudodelusions there were eight, while there were none of them in the “ pure simulation” group. Of individuals who simulated memory disorders there were three times less. Deserving of particular attention are the twenty-six cases of “ pure” malingering, in which the whole manner of simulating, the contents of the pseudo-symptoms produced, and the prisoner’s entire behaviour are of such a kind, that it seems improbable that the simulating individual could suppose that he would succeed in deluding his environment. The attitude of such prisoners is one of playful contradiction, usually coupled with irony and mockery with regard to the medical personnel; their behaviour is characterized by elements of acting and indeed of clowning; the absurdity of their utterances is glaring. Periodically, however, states of a certain inhibition make their appearance, and from time to time sudden changes of mood are visible, considerable tension, violent attempts at aggressive behaviour, and tendencies to self-mutilation. It was Mönkenmöller who, once upon a time, drew attention to that peculiar form of malingering, in which it is impossible to detect any intelligible purpose. In such cases malingering assumes the character of acting which gives the malingerer some satisfaction (“spielerische Simulation' 4, as Utitz called it); The picture of malingering gives one to think by its specific features, and is distinguished, from the other types of malingering, by its altogether exceptional primitivism and inconsistency. 92 per cent, of the prisoners who simulated in that way were recidivists with a considerable number of previous convictions to their names. In the anamnesis of nearly one-half of them alcoholism and brain trauma, as well as other chronical brain diseases, made their appearance. More than one-half of their total number have performed self-mutilation in prison. In the cases of “pure”, true malingering there appear, in the hospital material investigated, numerous prisoners with symptoms of encephalopathy (37.1 per cent.) and psychopaths (about 40 per cent.), as a rule described as impulsive, irritable, aggressive. Not a single malingering prisoner has been qualified as an individual with a normal personality. The prisoners who simulated mental disorders are recruited - 81 per cent, of them - from among recidivists, as a rule from among juvenile or young offenders: sixty-six per cent, of the investigated were under twenty-five years of age. They belonged to the category of offenders who commit common offences, mostly offences against property, with thefts predominating. Among the reactive mental disorders to be met with in forensic psychiatrist practice and in the prisons, two kinds of disorders may be distinguished. First of all, the group of disorders of the type of hysterical disorders, the majority of which has a more primitive character; they are: pseudodementia, Ganser’s syndrom, puerilism, states of incomplete stupor and of stupor, fancies with contents similar to those of delusions, and symptoms of conversion hysteria. It is precisely that category of disorders that oftentimes causes particular difficulties in practice, when it is a matter of distinguishing them from malingering. The second group of reactive disorders, with more psychotic symptoms, comprizes: reactive depressions, stupor, and syndroms with delusions and hallucinations and paranoid states. In this category of disorders disturbances of consciousness are much more clearly discernible than they are in the first. Bunyeyev, however, correctly emphasizes the fact that clinical experience points to the fact that in the several syndroms distinguished above there are frequently contained elements, of other reactive syndroms, and, moreover, in a considerable number of cases it can be observed, how, in the course of the disorders, one set of syndroms gives way to other symptom syndroms. Consequently, the clinical picture is usually considerably more complicated than would result from a description that would only take into consideration the most fundamental elements. Among the three hundred and fifty cases of reactive disorders with prisoners under investigation the several syndroms make their appearance In the following dimensions: Pseudodementia 90 cases 25.7 per cent. Puerilism 16 “ 4.6 per cent. Ganser’s syndrom 17 “ 4.9 per cent. Depressions 79 “ 22.6 per cent. Syndrom of stupor (41) 59 “ and states of incomplete stupor (18) 47 “ 16.9 per cent. Syndroms with hallucinations and delusions 13.4 per cent. Paranoid states 12 “ 3.4 per cent. Conversion hysteria 20 “ 5.7 per cent. Fancies with contents similar to delusions 10 “ 2,8 per cent. Pseudodementia, Ganser’s syndrom and puerilism between them account for 35.2 per cent, of the material investigated. Pseudodementia and puerilism frequently constitute the source of serious difficulties when it is a matter of distinguishing them from malingering, if hospital observation is of too short duration. Seventy per cent, of the above cases spent over three months on observation in hospitals, including nearly twenty per cent, who spent more than six months there. After a syndrom of pseudodementia, it may be sometimes observed the malingering of the extinct symptoms of that syndrom (metasimulation). Among the cases of metasimulation in the material under investigation in fifty-five per cent, malingering was precisely connected with pseudodementia. Reactive depressions are the second set, as far as numbers are concerned, in the material under investigation (22.64 per cent.). Reactive depressions are of various character. The obvious colouring of the majority of such states with hysterical traits frequently lends a peculiar stamp to the clinical picture, and may incorrectly suscitate a suspicion of malingering. Mental disorders with a stupor syndrom, as is well known, rarely arise as isolated type of reaction. Considerably more frequently stupor takes place after pseudodementia, Ganser’s syndrom and puerilism, not infrequently after a period of a seeming withdrawal of all reactive symptoms. What is more, after stupor there frequently appear once more symptoms of other reactive disorders, first and foremost those of pseudodementia (Bunyeyev, Pastushenko). In cases of incompletely developed stupor there frequently appear suspicions of malingering, even though such casses ought to be numbered undoubted mental disorders. When discussing cases with a hallucination and delusion syndrome one ought to remember that even in such cases the suspicion of malingering occasionally makes its appearance. This is influenced by the fact that the contents of the hallucination are closely connected with the prisonner’s own situation, that his behaviour is characterized by lively emotional reactions, and that he not infrequently manifests interest in his further lot, his family, etc. In fact the suspicion of malingering as a rule proves to be unfounded. Morever, it should not be forgotten that, in cases with a hallucination and delusion syndrome there not infrequently emerge serious diagnostic difficulties in connection with the posibility of the existence of schizophrenia. Among the reactive disorders observed with prisoners in the hospitals there were twelve cases of acute paranoid state. In this, relatively very infrequent, syndrom, which develops against a background of intensified fear and anxiety, and rapidly disappears under conditions of hospitalization, the existence of hallucinations, mainly visual ones, has also been found. The symptoms which approach delusions include the so-called confabulation, with contents resembling those of delusions (“wahnhafte Einbildungen” ), which had been described by Birnbaum more than fifty years ago. The inventing of occasionally the most improbable and queerest facts takes place against a background of usually glaringly expressed hysterical traits; occasionally elements of pseudodementia and puerilism become visible. All this together may suscitate serious suspicions of malingering; prolonged observation, however, makes it posible to find the existence of clearly reactive disorders. Of such cases there were ten in the material under investigation. Predominant among them were cases of persecutory pseudodelusions (eight cases), with the most absurd and fantastical subject-matter. In the remaining two cases it was grotesque grandiose pseudodelusions that made their appearance. Both the attitudes and the behaviour of all such individuals were, as a rule, in complete contradiction with the contents of their utterances. Those prisoners who exhibited symptoms of reactive mental disorders differ in an essential way from those prisoners who simulate pathological symptoms. First of all, there are considerably less recidivists among them: the percentage of the latter did not exceed 33 per cent, while with the simulators it reached 81 per cent. Among the prisoners with reactive disorders there are less individuals who would exhibit organic changes of the brain (23 per cent., as compared with 37,1 per cent, with the malingerers), while, on the other hand, the percentage of persons of the schizoid type is considerably larger (36 per cent., as against about 10 per cent, with the malingerers), as well as that of psychopaths with obvious hysterical traits (31.4 per cent., as against about 20 per cent, with the malingerers). A mere 4.5 per cent, of the total number of prisoners with reactive mental disorders under investigation were found to be persons whose premorbid personality did not suggest any suspicions concerning pathology; all the remaining ones figure, in the diagnoses, either as psychopaths, or else as persons with symptoms of encephalopathy. In spite of the lack of any exhaustive anamneses in a great many cases it was found possible to state that at least 17 per cent, of the prisoners sent to mental hospitals because of reactive mental disorders had already previously suffered from such disorders. The cases of reactive states of a protracted character, numerous in the material under investigation (32 per cent, among the cases dealt with in the Institute of Psychoneurology) make one realize the importance of a proper conception of the problem of reactive mental disorders with prisoners. In those cases states which could at first produce an impression of simulation were relatively numerously represented. Mistrust in such cases might well be increased by the fact that nearly one-half of them consisted of prisoners accused of the perpetration of homicide. A hospital observation which went on for many months on end, not only did confirm the diagnosis of a reactive mental disorder, but has also, over and above that, demonstrated that those mental disorders had, in a considerable number of cases, become so deep, that a large number of the patients had to be assigned for release from prison. Merely about 22 per cent, of the total of those suffering from protracted disorders recovered their health and could, later on, be prosecuted before a law-court. A working hypothesis in both prisons and forensic-psychiatric practice should therefore be the premisse that a pure malingering of mental disorders going on for a longer period of time is an altogether exceptional phenomenon, and that, as a rule, we have to do, in such cases, with reactive disorders. A different approach not only does run counter to the present-day state of psychiatrist knowledge, but is also highly harmful for both forensic and prison practice, as well as being inhumanitarian. [1] In order to avoid any misunderstandings it ought to be emphasized that we are here referring to cases of long duration, of a malingering of mental disorders going on for at least several weeks on end. Clumsy attempts at simulating pathological symptoms for a period of a few days, naturally, altogether elude a psychiatrist who is not permanently employed in the prison in question, and, in all probability happen much more frequently
Źródło:: Archiwum Kryminologii; 1964, II; 251-291
0066-6890
2719-4280
Pojawia się w:: Archiwum Kryminologii
Dostawca treści:: Biblioteka Nauki

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