Studies in Forensic Psychiatry | Page 3

THE PSYCHOSES OF PRISONERS
That mental disorder may be due to causes purely psychic in nature is acknowledged by
everyone. The older psychiatrists laid much stress on this point, a revival of which may
be seen in the present-day widespread psychoanalytic movement. The reaction to the all
too-embracing materialistic tendencies which have dominated psychiatric thought in
recent decades was bound to come. It was especially the clinician who gave the impetus
to this movement, because in pursuing the materialistic bent he found himself totally
helpless as a therapeutist in the great majority of mental cases, and was therefore
eventually forced to seek more promising paths.
Bleuler's attitude towards this question, because of the prominent position he occupies in
the world of psychiatry, is interesting.
"Bleuler, who succeeded Forel as Professor of Psychiatry and Medical Director of the
Cantonal Insane Asylum (Burghölzi) at Zurich, having become convinced that no
solution could be arrived at along this anatomical path for the many riddles offered by the
disturbed mental life, had for years chosen the psychological path. He was led to take this
course because he knew that of the chronic inmates of the asylum, only about one-fifth
showed anatomical changes of the central nervous system sufficient to explain the mental
deviations exhibited."[1]

The results already achieved by this change of attitude in psychiatry are sufficient
justification for its existence.
One became especially convinced of the potency of mental factors in the production of
mental disease from the observation and study of the psychoses of criminals. Here the
conflicts which lead an individual to seek in mental disorder a satisfactory compromise
are so concrete as to leave no doubt concerning cause and effect.
Kraepelin[2] asserts that mental disorders occur ten times as frequently in prison as in
freedom. The criminal, who in most instances is already burdened with a more or less
strong predisposition to mental disorder, upon being placed in prison finds himself at
once in a most favorable environment for a mental breakdown. It is true, imprisonment
acts more deleteriously upon the psyche of the criminal by passion, the accidental
criminal, but even the recidivist who would be expected to feel less keenly the painful
loss of freedom, falls a prey to the deleterious effects of prison life. The unfavorable
hygienic surroundings which are found in most prisons, the scarcity of air and exercise,
readily prepare the way for a breakdown, even in an habitual criminal. Above all,
however, it is the emotional shock and depression which invariably accompany the
painful loss of freedom, the loneliness and seclusion, which force the prisoner to a raking
occupation with his own mind, to a persistent introspection, making him feel so much
more keenly the anxiety and apprehension for the future, the remorse for his deed, that
play an important rôle in the production of mental disorders. This is especially true when
it concerns an accidental criminal, one who still possesses a high degree of self-respect
and honor. Imprisonment furnishes us with a great variety of mental disorders, the origin
of which can be traced in a more or less direct manner to the emotional shock and
influence upon the psyche which it brings about.
The psychogenetic origin of the psychoses of criminals can be established far more
clearly in prisoners awaiting trial. Here the deleterious effect of confinement upon the
physical health can be ruled out almost entirely, and the etiologic factor must be sought
for exclusively in the emotional shock which the commission of the crime and its
attending consequences provoke. The strong effect upon the psyche produced by the
detection and confinement, the raking hearings and cross-examinations, and the
uncertainty and apprehension of the outcome of it all are the factors that are at play here.
Reich,[3] in 1871, was the first one to call attention to the mental disorders of prisoners
awaiting trial. He could observe the development of mental symptoms even during the
first hours of confinement, and the relation between the psychosis and the emotional
shock of the situation at hand could not be doubted. He describes this acute mental
disturbance as follows:--"Already in the first hours or days after imprisonment, or soon
after a severe emotional shock, a sort of psychic tension sets in. The prisoner becomes
silent, chary of words, lost in brooding. He observes little that goes on about him and
remains motionless in one spot. His face takes on an astonished expression, the gaze is
vacant and indefinite. If he makes any movements at all they are hesitating, uncertain, as
those of a drunken man. Vertigo and aura-like sensations appear; severe anxiety
overpowers the patient, which with the entire force of a powerful affect crowds out all
other concepts and sensations and dominates the entire personality. Consciousness

becomes more and more clouded, soon illusions, hallucinations, and