Question V: Concerning Abnormal Persons

I. Various pathological states. - Causes of nervous agitation, not rarely occurring in present times, which more or less impede human liberty and moral life, are pathological states or diseases of the mind, which are so called not because the soul or spiritual faculties can be sick in themselves, but because, on account of badly affected organs of the body, specifically centers of the brain and sensitive faculties, they are impeded in action, either transitorily or permanently. Now those who labor under such a morbid state are commonly called abnormal. These are distinguished according to diverse genera, according to their diverse illnesses, the principal of which are numbered here:¹

¹ Theologians are accustomed to treat of these in the doctrine concerning human acts. We have taken the principal things from Vermeersch, Prummer, and Tanquerey; Salsmans also has excellent things in the work Geneeskundige plichtenleer and in the article Abnormalen in den biechtstoel, in Pastor Bonus, Aug. 1927. Besides, the following can be compared: P. Janet, Les Obsessions et la Psychasthenie, Les Nevroses, Nevroses et idees fixes; Dr. Raymond, Nevroses et Psychasthenie; Rauh and Revault, Psychologie appliquee a la morale; Ribot, Les maladies de la volonte; Grasset, Demifous et demiresponsables, Psychisme inferieur, La responsabilite des criminels; Axenfeld and Huchard, Traite des Nevroses; Pitres and Regis, Les Obsessions et les Impulsions; Van Velsen, Hypnotisme, suggestion, psychotherapie; Francotte, La raison et la folie (Rev. des Q. scient., d. 27); Vigouroux, Traite de medecine, t. III; Dubois, Les psychonevroses et leur traitement moral; Pere Raymond, Le guide des nerveux et des scrupuleux; Eymieu, Le gouvernement de soi-meme (vol. 2); Surbled, La morale dans ses rapports avec la medecine et l'hygiene, t. III; Boule, Questions de responsabilite (N. R. Theol. 1910); D'Agnel and d'Espiney, Direction de conscience et Psychotherapie des troubles nerveux; Capellmann-Bergmann, Pastoralmedezin (Latin and French versions); Familler, Pastoral-Psychiatrie; Bessmer, Storungen im Seelenleben, Die Grundlagen der Seelenstorungen, Seelische Hilfe bei Nervenleiden, Die Krankhaften Hemmnisse der Willensfreiheit (in Stimmen); Schloss, Propadeutik der Psychiatrie (French version); Huber, Die Hemmnisse des Willensfreiheit; Krieg, Die Wissenschaft der speziellen Seelensorge; Romer, Psychiatrie und Seelesorge (an excellent work although the author is Protestant); Weber, Zwangsgedanken und Zwangszustande in pastoral-psychiatrischer Beurteilung; Tummers, De nieuwere richting in de strafwetenschap; Van der Hoeven, Psychiatrie (where sometimes there are positivist conceptions); Roels, De Psychologie van den wil; Schimm Van der Loeff and Barnhoorn, Zielsziekten en hunne verpleging; Antonelli, Medicina pastoralis; Gemelli, De scrupulis, psycho-pathologiae specimen, etc., etc.

1. Phrenesis, in which the sick put forth false judgments that are radically incurable, because they are deceived by perpetual or temporary hallucinations, or have disturbed associations of imagination, so that their psychic life can be equated with the life of those dreaming. Hence in delirium (even if it is monomania, or hallucination circumscribed to one topic) they are not free; during intervals of delirium nothing of itself impedes liberty.

2. Obsession so occupies the mind that the obsessed person is bound to think or do certain things. It disturbs practical judgment sufficiently, so that more often room is left only for light fault, and mortal sin can scarcely be given in them. But, besides perpetual obsessions, there are others which are generated only in certain circumstances; whence outside the state of obsession, the sick are held by the precept of fleeing occasions of morbid excitation toward committing dishonorable things, and if they freely violate this, they are guilty.

To obsession are reduced phobias, fixed ideas, and more intense scruples.²

² Concerning remedies and education against obsession and phobias, cf. Prummer, Th. M., I, n. 95; and Vermeersch, Th. M., I, n. 85.

3. Blind impulses or invincible propensities can exist in a morbid state, whether they immediately obtain an act that is not deliberate, or overcome fruitless resistance, so that the act is nevertheless elicited. Hence some are merely mechanical or motor, which often are without affection, as, for example, in an idiot; others are psycho-mechanical or even merely psychic, which occur with more distinct perception and stronger affection, and often leave partial liberty.

All suppose a suggestible person, for his passive docility depends on the intensity of a certain phantasm which rather easily generates an insuperable motion. Thus some are known to be prone to lies, others to internal blasphemies, others to suicide or homicide, others to thefts, drunkennesses, or fires, according as they labor under kleptomania, dipsomania, pyromania. Yet with these must not be confused those who from habit are thieves, drunkards, liars, etc.; for these certainly are not abnormal, but sinners from malice.

It is not easily discerned whether the impulses are truly irresistible, but it must be judged from all circumstances whether liberty is only diminished or taken away. The latter can easily be supposed a) if the action cannot be explained by natural concupiscence, b) if after the evil action the soul has remained quiet and content, c) if something is done which one otherwise altogether abhors; yet liberty is not always taken away. Hence those things can be applied which are handed down in the Treatise on Human Acts concerning violence, fear, and concupiscence.

4. Abulia renders the will powerless to will efficaciously that which is desired, whether it remains idle, or, as if unwillingly, is compelled to seek or flee certain things against its practical judgments. In the first case, the sick person is often excused from certain positive duties, because liberty is at least sufficiently diminished; in the second case, what has been said concerning impulses holds.

Abulia, however, is sometimes not universal, but limited to certain acts or certain times. Besides, it can be voluntary and free in the cause, when someone knowingly and freely has induced this state, e.g., by constantly abdicating the will without sufficient reason.

5. Neurasthenia is a pathological state consisting in habitual fatigue of the nervous system from an organic or psychic cause, in which the nerves appear weakened and exhausted, so that the agent, although master of himself, labors under the greatest inconstancy and is greatly depressed physically and morally. Wherefore liberty is diminished, though not taken away. Hence the sick can rather easily be excused when, yielding to weariness, they neglect certain positive precepts, especially merely ecclesiastical ones, as an excessive burden. Nevertheless, of themselves they are to be judged to sin if, because of sadness, they seek shameful delights to which the illness itself does not impel.

6. Hysteria, although its cause is disputed, also carries with itself disorder and disturbance of the nervous system, but much graver than neurasthenia. It consists in an immense morbid suggestibility, from which sensibility is diminished or for a time extinguished in certain parts of the body (anesthesia), while in others it is rendered much more intense (hyperesthesia); there also arise motions of the body more or less disordered, and also vivid hallucinations or vehement passions which are very unstable and greatly impede the free exercise of the will, as also right judgment and moral sense. Hence in practice, only from all circumstances, and from the declaration of hysterical persons themselves, can it be known how much liberty remains in them. Yet hysterical agitation (crise, acces de grande hysterie) cannot be combined with grave guilt.

7. Still graver is larvate or hidden epilepsy, which impels one to perpetrate various strange, shameful, atrocious things: to inflict injury, blasphemies, shameful conversations, striking, homicide, etc.; not indeed constantly, but with longer intervals interposed, without the sick person retaining memory of all these things. Epileptic agitation or crisis certainly cannot be combined with grave guilt. But outside times of frenzy the mind is sane and perfectly free; unless sometimes a transitory psychic disturbance comes upon it.³

³ Speech is not instituted concerning hypnotism, because it is not an illness, but a phenomenon induced by an extrinsic cause.

All the aforesaid disturbances, even if they affect affection or the will, seem to draw their origin from an obscuring or diminution of intellectual cognition.

II. Conjectural signs of invincible inclination, by which it can more or less be discerned whether someone has yielded to an ineluctable inclination, are taken from various circumstances, especially taken together:

1. if on several occasions, and as if instinctively and swiftly after the manner of a mere instrument, he has placed some action, without any proper advantage, sensible delight, or satiation of a base instinct;

2. if he acted from a certain nervous anxiety or unrest which, when the action has been performed, immediately falls and becomes quiet; while on the contrary in a tranquil and quiet state he never acts thus;

3. if sincerely, and without any dissimulation, he wonders at his own operation, and spontaneously affirms himself conscious that he acted under the impulse of a certain violence;

4. finally, if he seems infected by hereditary blemish, by which, namely, his parents or blood-relatives also seem to labor under the same pathology.

Especially, in the matter of chastity and lust, there is sometimes given an abnormal propensity, as if invincible, toward sexual delight, namely sexual hyperesthesia or erotism, which according to the different sex is called satyriasis or nymphomania. Different species of this are numbered:⁴

⁴ Concerning these, our Questions concerning Chastity and Lust, pp. 99-102, can be compared.

a) a most vehement propensity to procuring self-abuse, especially among certain young persons of either sex;

b) exhibitionism, or an inclination to display in public the sexual parts or operations, every shame having been left behind;

c) homosexuality or uranism, that is, a perverse inclination toward the same sex, and as it were insensibility toward the other sex;

d) sexual perversion, by which venereal delight is procured from those things which are not by nature fitted to procure it. This is manifested in sadism, by which they inflict violence and torments on others to procure sexual delight for themselves; in masochism, by which, on the contrary, with a view to the same delight, they wish to undergo violence and torments; in fetishism, by which lust is excited by the sight or imagination of indifferent things (hair, shoes, cloths, etc.) which the mind conceives as associated with sexual things. In healing this, it is necessary to break apart that association and, as far as possible, erase it from memory.

III. As regards imputability and responsibility, the Determinists and Criminalists are not to be heard, who hold almost all malefactors as irresponsible sick persons, nor many physicians or cultivators of Psychiatry, who too easily deny the liberty and imputability of actions. But on the contrary, the better among them affirm not only that liberty generally is not extinguished, but also that the greatest influence is exercised by the soul upon the body, notwithstanding the latter's native propensity; and therefore in curing mental illnesses they are accustomed to use suggestion or moral persuasion, and indeed acknowledge the beneficial influence of the priest. Besides, for the greater part men are healthy, not abnormal; the latter constitute an exception.

Hence for practice let it be noted:

1. abnormal persons remain perfectly free in relation to other matters in which they are not abnormal;

2. in those matters about which they labor under abnormal affection, liberty and imputability are often attenuated and diminished, yet not in such a way that what is mortal always becomes venial;

3. generally, however, liberty is not extinguished; wherefore this is not to be supposed, but on the contrary sufficient liberty is presumed to be present;

4. even if liberty is greatly diminished or extinguished, this can be, and rather often is, voluntary in the cause: for the more conscious they are of invincible propensity, the more they are bound to flee occasions and circumstances of morbid excitation by which they are carried to dishonorable things;

5. in the case in which responsibility is greatly diminished or almost extinguished, this is not to be said to penitents, because it would increase their concupiscence and induce them to more rash acts, so that now, without any rein or restraint, they would rush into vice: namely, despairing of resisting, they would think that all things are now permitted to them.

Wherefore confessors judge imprudently who immediately from a few indications conclude to grave abnormality, and much more who therefore conclude to inculpability and excuse; they act still more imprudently if, for the sake of consolation, they reveal this to such penitents.

And thus especially in the matter of chastity, in relation to those who have an extraordinary erotic constitution (whether native, or adventitious from readings, spectacles, disordered loves), by which they are assiduously pressed by the lust of untamed flesh, so that the smallest spark produces a great fire which is accustomed to be extinguished only when passion has been fulfilled; they are filled with thoughts and phantasms and are agitated by vehement temptations of the flesh, and finally break forth into the deed. Such persons:

a) generally and of themselves cannot be excused, especially if they have come to the deed; nor even, if their responsibility is doubtful, can the aforesaid commotions and actions be permitted to them under the pretext that probably they are not formal sins: for it is not licit to expose oneself to the proximate danger of consent, even doubtful consent, but formal sin must certainly be avoided. This is, namely, a case in which systems of probability cannot be applied, but the safer way is to be chosen;

b) hence, as often as they at least have broken forth into the deed, they are rather to be presumed guilty, and then regularly they should not be permitted to approach holy communion without previous confession;

c) besides, unless they diligently use all natural and supernatural means, they are not capable of living chastely;

d) whence let the confessor pity them and help them with fatherly solicitude and great patience; therefore let him give courage to them for fighting, urge them to flee diligently all dangers of chastity, to pray frequently and renew a good purpose of resistance, to frequent the sacraments, to mortification in food, drink, and sleep, and also to use other physical means or certain medicines.

e) generally let him be kind toward them in conceding absolution, even if they are recidivists, because of their intrinsic fragility; yet if they were also in occasions, they would have to be treated more rigorously because of their proclivity to pleasures.

IV. As regards care and medical treatment, it must be noted: those who are abnormal in an acute degree are simply to be committed to a trustworthy and Catholic psychiatrist physician; for others the confessor can contribute to healing by rational persuasion and suggestion, so that, namely, obsessions, fixed ideas, and harmful impressions may gradually be diminished and erased from the mind. For this, divine help having often been invoked,

1. let him excite the confidence of the penitent: for it is necessary that the latter wish to be healed and understand that this must be procured by his docile submission and education of the will;

2. let him proceed with great kindness and at the same time inflexible firmness;

3. let him seek indirect means by which he may little by little turn the mind of the penitent away from harmful things and fill it with healthy ideas and good affections. Thus, for example, let him act so that the abnormal egoism of the hysterical person may be wiped away; for this let him also counsel honorable distractions and delights, prohibit excessive exercises of mortification, and prescribe works of mercy and charity toward the neighbor.

V. Observation concerning hysterical persons. - Since the confessor must also hear hysterical persons of either sex, he must be fortified against the dangers and harms to which he is thereby exposed.

For this it will be useful to know the distinctive signs, or the stigmata of hysteria. These symptoms are almost infinite and always variable, so that in hysteria nothing seems constant except its inconstancy. But we hand down the principal signs to which the others are reduced.

A. Physiologically, hysteria is a mental illness which is manifested in a threefold phase: the first is the sensation of a little globe ascending from the belly to the throat, where it produces the sense of a certain constriction; the second is a nervous crisis with cries and destitution of the senses; the third is anesthesia or even partial paralysis.

B. Psychologically, however, the distinctive character, says Cardinal Mercier (Psychologie, n. 233), is mental incapacity for synthetic coordination, and therefore perpetual mobility of soul and abnormal inconstancy. "A certain marvelous change of affections of joy and sadness even to anxiety, irritability, fear, love, hatred, whose causes are in no way understood, renders these sick persons most troublesome to all who must deal with them." Thus the physician Capellmann, Medicina pastoralis, on the fifth precept, appendix concerning hysteria; and Prummer, Th. Mor., I, n. 96: "The hysterical person now exults with jubilation of mind, afterward because of futile reasons is saddened even to death; today with great confidence she approaches the confessor or physician and most faithfully observes their commands; tomorrow she complains about the confessor and physician as men without heart and intelligence." From this:

1. Under the respect of sensation, perceptions are increased and exaggerated beyond measure in such a way that they also produce hallucinations. "Small impulses upon the sensible nerves," says Capellmann (l. c.), "move them to most vehement complaints concerning bitter pains; phantasy proposes images to them and brings them into a state which is very similar to ecstasy and somnambulism. Not rarely, under a simulated fervor of religion, lustful excitement, growing even to nymphomania, is concealed rather skillfully, so that those standing around, indeed the physicians themselves and younger clerics, are deceived in a pitiable manner." On the contrary, the illness can sometimes be so aggravated that a person otherwise modest casts away all shame and openly tempts others to immodesty.

2. Under the respect of association, images and representations are so vivid that they are held as reality. From this follows a defect of truth and truthfulness, and as it were an appetite of lying. "This defect manifests itself both in actions and in words. The hysterical person deceives herself, deceives others, although she does not always do this knowingly or from malice. Hence in her are sometimes found actions which, considered at first sight, appear miraculous, e.g., heavenly visions, diabolical apparitions, fasting protracted for several weeks (but secretly she eats), indeed also bloody stigmata in the hands, feet, and side. Not rarely also the hysterical person narrates filthy lies concerning the matters and deeds of others, indeed most wickedly blackens the honor of the confessor" (Prummer, l. c.).

3. Under the respect of affection, there is exaggerated egoism, or an immense propensity of ordering all things to oneself, so that all may attend to oneself. "In very many of these sick persons there arises an untamed desire of moving mercy and pity, of acquiring esteem for themselves and of turning the eyes of all to themselves" (Capellmann, l. c.); from which is born a demand for emotions and for intense life with the risk of dangers. "The hysterical person is accustomed to refer all things to herself. Wherefore she continually laments that other men do not consider her enough or offend her by manifold and actually futile things. From this she also tries that others may pity her. She feels great satisfaction if other men acknowledge or admire her pains, anxieties, labors. But if others seem to neglect her, then with all her strength, even by exaggerations and lies, she obtrudes herself and her state. She does not care for the neighbor except because of egoism. Hence also she often offends the neighbor, not indeed by grave deeds, but as if by needle-strokes, so that those cohabiting or often conversing with her must tolerate many inconveniences. In one word: the hysterical person, whatever she does, whatever she suffers, refers all things to her own honor or utility or satisfaction" (Prummer, l. c.).

From these things it is easily understood how greatly the cleric must beware of hysterical persons, Capellmann wisely admonishes (l. c.), "lest he be deceived by things sometimes very strange, and lest he be deceived by fraud from those sick persons who are very cunning and truly obstinate in pursuing the things which they have proposed to themselves. These sick persons, that they may satisfy their desire of deceiving, refuse neither pain, nor labor, nor troubles of whatever kind. Since perverse thoughts and frauds, whether known by the sick as such or not known, very often regard fervor of religion and piety, there is rather often given to a cleric, and especially to a younger one, an occasion that he truly be wearied by these sick persons, and often know late that he would better never have given work to them." Indeed, since they are liars, not rarely they falsely accuse others concerning lust committed with them; for this reason a priest outside confession should not speak alone with one alone, so that he cannot be calumniously accused.

It should be noted, however, that in hysteria, especially in a hysterical paroxysm, anyone very rarely dies; wherefore the priest, as regards administration of the sacraments, if a person whom he knows to be hysterical is laboring under a more intense crisis, must be cautious.

VI. Warning. - From the fact that in the civil forum certain persons are absolved from crime, one must not conclude to the absence of all imputability and guilt. Human law does not punish except those who are certainly proved guilty by external signs; besides, several crimes are not commonly punished unless they are committed by men of sound mind, of which sort certainly are not those who labor under psychological illness. Yet in the forum of conscience they can nevertheless be guilty.