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The defective as seen in prison is generally of the feeble-minded type, the idiot is of course never met with, the imbecile and moral imbecile, rarely1. Whatever the variety of defect the accused is generally found to have acted alone, and this for the obvious reason that his defect renders him a dangerous partner in a crime. Occasionally he may be utilised to pick the chestnuts out of the fire for an astute criminal who has taken precautions to protect himself from blame if detection results; but this, as far as my experience goes, is quite uncommon. I have elsewhere referred to a case of theft in which two defectives were concerned together, and this is, I believe, a quite unusual occurrence, but it is of some medico-legal importance, as two insane persons have been known to conspire together to commit a serious criminal offence, and the existence of such a conspiracy in two persons similarly affected mentally may be suggested by the prosecution as evidence contra-indicating mental disease or defect.

In those defectives in whom conduct is an important feature, diagnosis in any institution may become difficult by reason of the regular and simple life there led, and probably most people will agree that the mental patient usually appears to be less abnormal in an institution than he really is. In those high-grade cases who remain under observation for some considerable time, and who before reception have been subjected to exposure and privation, there may result such improvement that whereas at first certification was easy and necessary, later it becomes difficult or unnecessary. Similarly, a defective may be received who has been living under favourable conditions up to the time of admission with consequent insufficient evidence to justify certification, but may be again received at a later date having undergone recent privations, and then certification may present no difficulties.

In the diagnosis of moral imbecility a very detailed history, in prison work, is of course essential. I may recall that some, like myself, consider that in moral imbecility there need be no intelligence defect, others assert that some defect of intelligence always exists, some go as far as to say that they have never seen a case of moral imbecility. In my own experience it is a rare condition to meet with in prison, but I have no doubt that it exists, and that the diagnosis is more difficult and requires more thought and care than in any of the other forms of mental deficiency. The older the individual, the longer and more intimate the history, the more probability is there of an accurate opinion being formed. It will

1 Of 200 consecutive cases of male defectives seen in prison, 180 were diagnosed as feeble-minded, 15 as imbeciles, and 5 as moral imbeciles.

probably be admitted by most observers, that a good many cases of alleged moral imbecility in young people are due to mental conflicts, and if these can be remedied there is some prospect of normal conduct resulting. The knowledge or suspicion of a person that he is illegitimate, or that in some way the relations of his parents to one another are unlike those belonging to others, or some sex, occupational, or environmental conflict may result in a course of anti-social conduct. But when these cases have been eliminated as far as is practicable, we find persons who throughout a long career commit criminal acts which are unnecessarily detrimental to their own welfare, to whom the criminal action can bring no profit, in which they run perilous risks themselves, jeopardising their own and the lives of others and even committing murder for a totally inadequate reason. The inducement to commit crime in these cases is totally out of proportion to what is required to cause even a weak character to succumb, there may be in fact no temptation at all in the ordinary acceptance of that word, but in carrying out a crime they may show skill, cunning, and determination. The delinquencies are frequently not restricted to one class of offence in the career of the moral imbecile. The differential diagnosis between the habitual criminal and the moral imbecile may be difficult; the earlier the delinquent career commences, the more the offences seem to result from temperament and not temptation, to be uninfluenced by environment, to lack precaution and foresight, to exhibit a wanton character, to demonstrate inability to profit by experience, and the more they appear to be committed for a purpose which when achieved is disregarded, the more probability is there that the condition is due to moral imbecility. Of fundamental importance in the diagnosis is the fact that the moral imbecile does not take elaborate precautions to hide his crime, or avoid punishment. Those cases of socalled irresistible impulse, which are uncommon in prison practice, exhibit usually symptoms indistinguishable from Impulsive Insanity, and it is under this diagnosis they are usually dealt with, as all the requirements necessary to meet the definition of moral imbecility are not available. The condition of irresistible impulse to crime does undoubtedly exist, as in the case of an elderly man of the labouring class who, after reaching adolescence, had on very numerous occasions snatched a bottle of scent off a chemist's counter and run away with it. He could not tell me why he had ever done it, he had no use for the article, and he had

⚫ been repeatedly punished for it without effect. In the still rarer cases associated with violence the diagnosis tends to be arrived at earlier in the history of the case, on account of the more striking features met with

in those instances. But whether cases of this nature be regarded as impulsive insanity, or moral imbecility, it behoves the medical witness to form definite ideas concerning any particular case before he goes into the witness-box, or a similar fate may befall him as that which was experienced by a medical man, unversed in mental conditions, who expressed the opinion that a very deliberate and premeditated murder was due to an uncontrollable impulse. He was asked by the learned judge how he would in that particular case distinguish between an uncontrollable impulse, and an impulse which the prisoner did not wish to control, and was unable to supply the answer.

I may perhaps here refer to those most difficult cases to deal with, the young prostitute. Much controversy arises about this class of offender. Some people, as is known, hold that the offence in itself is an indication of mental defect, but prostitution was recognised as a profession many centuries before Christ, and I believe I am right in stating that of the numerous references to harlots in the Bible none mention anything which could be construed as indicative of mental disorder or defect in these women. The histories of other countries also contain the names of women of intelligence who have been prostitutes, and probably very many medical men in the course of their practice come across women of this class of decided intelligence. A consideration of the after career of some of these seem to indicate that their sex delinquencies were due to adolescent instability; some are due to nympho-mania, early insanity, drug habit, but the majority to indolence and vanity; others to overdevelopment of physical and sex characteristics, abnormal, perhaps not very uncommon, but not defective or insane. A few are, I believe, undoubtedly moral imbeciles, and others feeble-minded. But there is in my opinion reason to suppose that people of both sexes who have up to a certain period led sexually moral lives may, when once they have gratified by legitimate or other means the full sex instinct, experience for a considerable time such difficulty in dealing with their newlyaroused sensations and emotions, that they fail to control themselves; and I believe I have seen examples of this in both sexes, and that some lives of immorality and prostitution so arise. When any case comes up for consideration some help in determining whether any mental disorder or defect is present, or not, can be obtained, if the origin and circumstances of the first sex delinquency can be ascertained. The frequency of the immorality should also be considered, as an occasional lapse in a woman does not seem very different from a similar lapse in a man, and when it occurs in that sex it is not usually considered due to mental

disorder or defect. The most helpful fact in forming an opinion as to whether certifiable defect or not exists, apart from marked co-existing evidence of feeble-mindedness or moral imbecility, may be the age at which the delinquency commences.

Each case, of course, requires individual consideration, but it does seem advisable that these points, with others, should be considered before arriving at an opinion whether defect is present or not.

In bringing these somewhat disjointed remarks to a conclusion, I should add that I have made no attempt to bring to notice any original work in this important field. My main concern has been to express some views I have formed in the light of my own experience. But interesting enquiries are being conducted at the Borstal Institution, by Dr Methven, regarding the prognosis as to the future success of those youthful offenders under his care in relation to their mental ages; by Dr Grierson of Holloway Prison in connection with prostitution and mental ages, and by my colleague Dr Rixon concerning the mental age of the ordinary remand prisoner.



DR EAST'S suggestive paper raises many problems of great interest and importance to the educational psychologist. My own tentative views upon them are derived from an experience limited almost exclusively to juvenile cases. The chief issues, likely to be discussed at this meeting, turn, mainly (I think) and at bottom, upon the definition of the phrase 'mental deficiency.' What do we mean by the term 'mental'? And how deficient must a person's mind be before he can be considered technically 'defective'?

'Mental' is the adjective of 'mind'; and to the psychologist 'mind' includes not only intelligence, but also temperament and character. Therefore, so far as psychological usage is concerned, mental deficiency is applicable, not only to defect in intelligence, but also to defect in temperament and character, if such can be shown to exist. It would appear, indeed, that those who framed, and those who administer the Mental Deficiency Acts, have had chiefly in view defect in intelligence; but the addition of moral imbecility to the other three categories seems to imply that temperament or character is also included within the scope of the Act.


I may deal first, and most briefly, with defect in general intelligence, mental deficiency in the narrower and more familiar sense.

Here a further difficulty arises. The definitions inserted in the various Acts give a different significance to the term 'deficiency' as used of children and of adults. With children a mental ratio of 70 per cent. is the generally accepted borderline for defect in intelligence, although it cannot be too often repeated that a mere quantitative limit of this nature provides only a rough guiding principle, and is by no means the sole criterion upon which diagnosis must be based. Children whose intelligence falls below this level appear to be "permanently incapable of receiving proper benefit from the instruction in ordinary schools" at any rate as organised at present. Were adequate provision made for the 'merely

1 A contribution to the Symposium presented at the Joint Meeting of the Educational Section and the Medical Section of the British Psychological Society, April 25th, 1923.

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