Abnormalities which Arise from Morbid Disturbance of the Psychic Faculties

Here it is necessary to distinguish: 1. amentia properly so called, by which the operation of the intellect is wholly disturbed with respect to certain matters; 2. a habitual psycho-somatic abnormal disposition, which nevertheless does not reach a full disturbance of reason; 3. psychogenic reactions. We shall speak of each.

Does ignorance cause the involuntary? - Ignorance with which someone acts either has itself causally in relation to that which is done, or has itself merely concomitantly with respect to that which is done. It has itself concomitantly "when ignorance concerns that which is done; nevertheless, even if it were known, it would still be done. For then ignorance does not induce one to willing that this be done, but it happens at the same time that something is done and unknown; as... when someone would indeed wish to kill an enemy, but, ignorant, kills him, thinking he is killing a deer. And such ignorance does not make the involuntary" (namely contrariwise), "because it does not cause something that is repugnant to the will; but it makes the non-voluntary" (or the involuntary merely privatively), "because what is unknown cannot be actually willed." S. Th. 1. 2. q. 6. a. 8.

But it makes the non-voluntary, whether that merely concomitant ignorance is involuntary, or whether it is not merely concomitant, but voluntary. Nevertheless there is a distinction between involuntary and voluntary ignorance in the case; because involuntary concomitant ignorance, since it simply takes away the voluntary, makes something simply non-voluntary. But voluntary concomitant ignorance, since it does not simply take away the voluntary, for it is voluntary, makes that which is done with that ignorance non-voluntary indeed in itself, but voluntary in some way in the cause. S. Th. de Malo, q. 3. a. 8.

Voluntary in the cause, namely insofar as the ignorance concerns a thing which ought to have been known, and perhaps someone knowing would not do what he does ignorantly. And if certainly he would do it even knowing, the voluntary is still had indirectly in the cause, by reason of that evil disposition which the willed ignorance leaves intact, and by reason of that action, for example hunting, which was the cause of the consequent act, for example homicide. To the point Suarez, on 1. 2, tr. 2, d. 4, s. 2, n. 19: "That ignorance does not excuse from fault; therefore neither does it take away the voluntary. He is bound to expel that ignorance in order to avoid the act, and voluntarily omits to do this; therefore he also acts voluntarily, at least indirectly. Therefore it matters nothing that this ignorance is not the cause of the act, and that if knowledge were present, the act would nevertheless take place; both because, although we grant that that act is not voluntary in ignorance as in a cause, nevertheless that ignorance will be a sufficient condition for that act to be voluntary indirectly, insofar as man is bound and can avoid it and does not do so; for what he would have done if knowledge existed does not excuse him, but rather in a certain way accuses him more, because that is an evil disposition and contrary to the obligation by which he is bound to avoid the act; and also because that effect is voluntary in another act directly willed, as, for example, the killing of a man in hunting. But voluntary ignorance, although it is concomitant, is the reason or condition that that prior act of hunting be done imprudently or incautiously, and consequently that in it the effect thence following is judged to have been willed."

Indeed, notwithstanding that evil disposition, he was still then bound, indeed much more, to know; and knowing, perhaps, notwithstanding that evil disposition, he would not have committed the monstrous crime with open eyes. S. Th. 1. 2. q. 6. a. 3; Billuart, de Act. hum., diss. 1, art. 6, I say 3.

If ignorance is not merely concomitant, or does not have itself merely concomitantly in relation to that which is done, but is causing, or has itself causally, namely is the cause of doing that which is done, then that ignorance is either voluntary, or consequent upon a free act of the will, or it is not voluntary, or antecedent to a free act of the will. A free act of the will, namely concerning the ignorance itself, not concerning that which is afterward done from that ignorance. "But consequently," says S. Th. ibid., "ignorance has itself to the will insofar as it is voluntary."

Therefore when ignorance of this kind is the cause of doing that which is done, "since it is itself voluntary... it cannot cause the involuntary simply" (that is, contrariwise; since that which is done is voluntary in the cause from which it proceeds, i.e. in that willed ignorance). "Nevertheless it causes the involuntary according to a certain respect, insofar as it precedes the movement of the will to doing something, which would not be if knowledge were present," ibid.; that is, although that movement of the will is voluntary in the cause, nevertheless in itself it is altogether involuntary, for it would not be if knowledge were present. L. 1. 5. n. 4.

But if the causing ignorance, or that which is the cause of doing what is done, is not voluntary, or is antecedent, then ignorance causes the involuntary simply, since that which is done, by the very fact that it is caused by ignorance, would not be if knowledge were present, and accordingly is against the will. Nor indeed is that willed in itself; nor in any way willed in the cause. Therefore it remains totally or simply involuntary. "But antecedently," says the Holy Doctor ibid., "ignorance has itself to the will when it is not voluntary, and nevertheless is the cause of willing what otherwise one would not will; as when some man is ignorant of some circumstance of the act which he was not bound to know, and from this does something which he would not do if he knew: for example, when someone, diligence having been used, not knowing that someone is passing along the road, shoots an arrow with which he kills the passerby. And such ignorance causes the involuntary simply."

S. Th. 1. 2. q. 76. a. 1. As regards the insane, it is certainly not always established that they are not sufficiently in possession of themselves in an act of sin. Nor likewise is it established whether those who are hypnotized, and in hypnotic sleep execute the evil commands of the one hypnotizing, are not also sufficiently in possession of themselves. But in these cases the voluntary can easily be in the cause.

127. On account of the intimate connection between body and soul, there are certain pathological states in which liberty is diminished or removed. All states of this kind directly affect the nervous system, and indirectly the will. Among these we shall treat: 1. concerning abulia and invincible propension, which in the state of wakefulness especially harm liberty; 2. concerning neurasthenia, hysteria, and epilepsy, which in the same state harm liberty less; 3. concerning hypnotic sleep and suggestion.

² Ribot, Les maladies de la volonté, 18th ed., Paris, 1904; translated into English by Fitzgerald, The diseases of the will; more briefly Rauh and Revault, Psychologie appliquée à la Morale, Paris, 1900, p. 282-286.

128. (A) Abulia (lack of will) consists in a certain incapacity of efficaciously willing what is desired. Positivists infer that this is a disease of the will itself from the fact that it is found in men otherwise apparently sound and robust, who by their own initiative cannot or will not will what otherwise they desire and are able to accomplish. But from these facts this conclusion cannot be drawn; for even in those who seem sound, a disease of the nerves or brain can lie hidden. Wherefore all those who admit the spirituality of the soul teach that abulia arises from a certain pathological state of the body, by force of which the organs are not in that condition in which the will can expeditiously exercise its operations.

Sometimes this impotence is universal; sometimes it is limited to certain acts or certain times.¹

¹ Ribot reports many examples of abulia, op. cit., p. 38-59.

Nothing certain is known concerning the cause of this disease;² but those incur the danger of falling into it who more promptly and easily, without sufficient reason, abdicate their own will and show themselves sluggish; or who abuse soporific medicines, for example opium.³

² Ribot gives a physiological explanation, p. 50-56.

³ In this way the very well-known T. de Quincey had fallen into abulia; cf. Ribot, p. 40-43; T. Quincey, Confessions of an opium-eater.

Whatever the case, when the disease has prevailed, liberty is much diminished, and sometimes it seems to be removed at least as regards certain acts; and therefore the omission of acts which are prescribed is, in itself, either little free or in no way free; but it is free in the cause when someone knowingly and freely has induced this state by his own fault. - Nor is such a disposition altogether incurable; for, with relatives and friends helping, those who labor under abulia begin to will and execute easier things, and step by step more difficult things also, provided they are persuaded that this is not arduous.⁴

⁴ Ollé-Laprune, Le prix de la vie, Paris, 1896, ch. 24, p. 304-317.

129. (B) Vehement and invincible propension.⁵ Here there is question of those propensions which, by an almost unavoidable motion, impel someone to doing that which otherwise he abhors. Sometimes certain persons are so suddenly and vehemently pressed by these impulses that they are not conscious of the things which are perpetrated; but others are conscious of this violent propension and flee to friends so that, being imprisoned or bound by them, they may be able to avoid the evil action to which they are impelled.⁶ Thus certain persons are carried unwillingly to suicide, homicide, theft, drunkenness, during the whole time in which the crisis endures, and afterward, when the crisis has been overcome, they detest all these things and become masters of themselves.

⁵ Ribot, op. cit., p. 73-95.

⁶ "These irresistible impulses are, some unconscious, sudden, followed by immediate execution, without the subject having even had time to take knowledge of them, without his being informed of his action either before or after; the others are fully conscious: the sick person feels that he is no longer master of himself, that he is dominated by an interior force, invincibly pushed to commit acts which he reproves and of which he has horror. A young man adores his mother and is haunted by the idea of killing her; to prevent himself from executing his atrocious desire, he is obliged to beg that he be tied in the barn like a wolf." (Rauh and Revault, op. cit., p. 283).

Whence from all the adjuncts it must be judged whether, in these cases, liberty is only diminished or is removed. In practice, however, as soon as someone is conscious that a crisis is occurring, he ought to ask friends to take care that the invincible propension not pass into act. - Moreover all those things by which propensions of this kind can be induced ought carefully to be avoided.

130. (A) Neurasthenia is a certain pathological state in which the nerves appear weakened and exhausted, so that the agent, although master of himself, labors under the greatest inconstancy and is much depressed physically and mentally. Generally a state of this kind is caused by various excesses, whether by working too much, or by indulging pleasures, or by abusing certain narcotic medicines;¹ sometimes, however, it is transmitted by heredity. It affects the whole body, and therefore can be called not so much a disease as a cohort of diseases.

¹ "All the passions, or even excessive sentiments, are capable of bringing on neurasthenia; whether it is love or ambition or filial affection, or again cupidity, which comes into play, it will suffice that their development be hindered for a consequent neurasthenic state to declare itself. In the intellectual sphere, all excesses of work can be incriminated, and, if moral preoccupations are joined to it, which is not rare, the combination of the two orders of causes will bring on neurasthenia still more easily." (Dr. Block, cited by H. Vigouroux, Traité de Médecine, t. III, p. 125.)

From this weakness of the nerves the will becomes very infirm and unstable, unfit for strongly resisting evil propensions; wherefore liberty is diminished, though not removed. - Besides physical medicines, which physicians prescribe, spiritual remedies are of much profit, such as confidence in God,¹ a firm will and hope of repelling this disease, moderation in acting, a quiet life far from the tumult of cities, the society of friends who are able gently to console the sick person and often strongly to exhort him to acting well and quietly.

¹ This is candidly acknowledged by a man otherwise unbelieving, who wrote concerning nervous diseases: "Religious faith could be the best preservative against these maladies of the soul and the most powerful means for curing it, if it were living enough to create in its adherents a true Christian stoicism. In this state of soul, alas! so rare in right-thinking circles, man becomes invulnerable. Feeling himself supported by his God, he fears neither sickness nor death. He can succumb under the blows of a physical disease, but morally he remains standing in the midst of suffering; he is inaccessible to the pusillanimous emotions of neuroses." Dubois, Les Psychonévroses et leur traitement moral, Paris (Masson), 1904, p. 245-246; in the same place various therapeutic and moral means for curing those diseases are described; cf. Feuchtersleben, Hygiène de l'âme, Paris (Baillière), 1904, p. 147.

131. (B) Hysteria (from the Greek word hystera, uterus, because formerly this was thought to be a disease of the uterus) is also a disordering of the nervous system, but much graver than neurasthenia; it consists especially in this, that the sensibility of the nerves is diminished or for a time extinguished in certain parts of the body (anesthesia), while in others it is rendered much more intense (hyperesthesia). This irritability of the nerves changes the whole nature of hysterical persons, disturbs the mind, weakens the will, and opens the way to hallucinations: they vividly represent to themselves phantasms, which induce a state akin to ecstasy or somnambulism. Prone to diverse and contrary affections, and laboring under the greatest inconstancy, they pass immediately from laughter to tears, from love to hatred. Often they have recourse to lying: they simulate sentiments of soul which they do not have, piety, and imaginary visions; sometimes they falsely affirm that force has been brought upon them by a person whose name they reveal, describing the minute circumstances of the crime, and on that account they excite discords and scandals. Not rarely they are prone to theft, and they easily steal whatever pleases them. - Therefore let priests beware lest they be deceived by these persons.

Not only women, but also men can incur hysteria: a soft life, abstinence from physical exercises, the reading of romantic books which excite the imagination and disturb the heart, premature and excessive study, lustful excesses, in one word whatever induces physical debilitation and agitates the nervous system, disposes one toward it. - There are various degrees of hysteria and various stages, which are described by physiologists; sometimes the disease grows stronger and reaches a paroxysm,¹ which by physicians is commonly called great hysteria (la grande hystérie).

¹ P. Richer, Etudes cliniques sur l'hystéro-épilepsie; Axenfeld and Huchard, Traité des névroses, p. 967-1012; Ribot, op. cit., p. 115-125; Surbled, op. cit., t. IV, p. 72-78; Antonelli, Medicina Pastoralis, Rome, 1905, t. I, n. 436-449. - Physiologically hysteria is described thus: "Hysteria is a neurosis with numerous and varied manifestations. The three principal ones are: the sensation of a ball which starts from the belly and rises back to the throat, where it determines a feeling of constriction; nervous attacks accompanied by cries, by loss of consciousness; anesthesias or partial paralyses." (Vigouroux, op. cit., p. 95). - Psychologically it is described thus by Huchard, apud Ribot, p. 117: "Their character changes like the views of a kaleidoscope, which could make Sydenham say with reason that what is most constant among them is their inconstancy. Yesterday they were playful, amiable, and gracious; today they are in a bad humor, susceptible and irascible, growing angry at anything and nothing, gloomy and sulky by caprice, discontented with their lot; nothing interests them, they are bored with everything. They experience a very great antipathy against a person whom yesterday they loved and esteemed, or on the contrary manifest an incomprehensible sympathy for another... Sometimes their sensibility is exalted by the most futile motives, while it is scarcely touched by the greatest emotions... By turns gentle and violent, beneficent and cruel, impressionable to excess, rarely mistresses of their first movement, incapable of resisting impulses of the most opposed nature, presenting a defect of equilibrium between the superior moral faculties, the will, the conscience, and the inferior faculties, instincts, passions, and desires."

It is very difficult to define whether and in what degree hysterical persons remain free. Whence, in practice, only from all the circumstances, and from the declaration of the hysterical persons themselves (to which, however, one must not entirely give trust), can it probably be known what liberty remains in them. - Remedies are of two kinds: physical, which a wise² physician will prescribe, for example physical exercises, assiduous labor, although moderate; and spiritual, especially a sufficiently constant effort for at once restraining vain phantasms and bridling the passions, while hysterical persons are masters of themselves.

² I say wise; for, since hysterical persons fall into hypnotic sleep more easily than others, certain physicians, for the sake of experiment, hypnotize them and often render their condition worse.

132. (C) The epileptic disease is likewise a certain disordering of the nerves which, with longer intervals interposed, induces a crisis of greater or lesser duration, in which the sick person is not master of himself. Now, among epileptics, there are some who do nothing morally evil; but there are others who are vehemently impelled toward something dishonorable, for example toward inflicting injuries on others, toward stealing, toward blaspheming, or toward speaking or acting basely, without retaining any memory of all these things. In which case they are not free;¹ nor can the offenses thus perpetrated be imputed to them, provided they are not voluntary in the cause.

¹ "Some sick persons suddenly begin to utter incoherent words, coarse words, insults against the persons who surround them. Others commit acts of brutality, strike persons, break objects. Under the influence of the impulse, the epileptic is capable of wounding, of killing the persons who approach him; and he is all the more terrible because his vigor, in those moments, is prodigious, and because he strikes with remarkable sureness... After a few moments the sick person comes back to himself, retaining no memory of what happened." (Féré, L'épilepsie, p. 51-52). Cf. Surbled, op. cit., p. 78-82.

Order of treatment. For our end and according to the plan of the present work, it will suffice that, after a general notion has been set down, we touch very briefly upon the individual diseases and their force upon free choice.

There will be two articles of this chapter. In the former we shall hand down various notions; in the latter, we shall weigh troublesome cases which occur in matters of lust.

I. What diseases of the mind are. In this place we treat of those infirmities which permanently or transitorily take away or diminish free choice, and which are called diseases of the mind, not because the mind itself, or the spiritual faculties, can be diseased in themselves, but because, on account of the badly affected centers of the brain and the sensitive powers, especially the phantasy, which they use, they are subjectively impeded in their action. Indeed, apart from its depraved habits, which do not take away liberty, the will is not impeded otherwise than by the intellect being impeded. "Insofar as reason remains free and not subject to passion, so far the motion of the will which remains does not tend of necessity to that to which passion inclines." Thus St. Thomas already wrote accurately, 1, 2, q. 10, art. 1.

II. Division. These diseases are called organic when some lesion is found in the material organ; but functional, those which allow the body to be truly or apparently intact.

They can be reduced to a twofold generic form, since some seem to affect the higher faculties more directly, others rather indirectly, insofar as you would say that by the impulse of the lower powers the higher faculties are imperiously drawn. But they are not drawn except because, by a subjective impediment, the higher faculties have been made weaker, so that they now cannot restrain the lower powers. Wherefore these various diseases are finally of one kind. Let us hand down these few things about most of them.

Phrenetics set forth false judgments which are radically incurable, because they are deceived by perpetual or temporary hallucinations, or at least they have disturbed phantastic associations, so that their psychic life can be equated with the life of those dreaming. In the delirium itself, even if it seems circumscribed by one subject (monomania), they are not free. During the intervals of deliriums, nothing per se impairs liberty.

The demented labor under a certain often increasing imbecility and dullness of mind. Whether they are "idiots," or whether their powers have been exhausted by old age or infirmity, they labor under a more perpetual privation of free choice.

Obsession so occupies the mind that the obsessed person is constrained to think or to do certain things. And it disturbs practical judgment enough that it allows place only for light fault. But besides perpetual obsessions, others arise only in certain circumstances. Wherefore, outside the state of obsession, the sick can freely violate the precept concerning the fleeing of occasions of morbid excitation for committing indecent things.

When there is question of an object toward which there is no natural inclination, the sick person, by repeated acts demanded by the obsession itself, can as it were tire it out, exhaust it, so that morbid anxiety is removed and thus the agent is freed from obsession. But at the same time, through repeated acts, the propensity is increased if any such propensity arises per se from the object. Wherefore this method cannot be applied in a sexual matter, as the physicians Pitres and Regis themselves warn ¹.

¹ Les Obsessions et les Impulsions. Paris, 1902.

To this are referred impulses which are called invincible; and such impulses can exist in a morbid state, whether they obtain an immediate and non-deliberate act, or whether the act is elicited after fruitless resistance. They suppose a person especially capable of passive induction, or "suggestible." This excessive docility depends upon the abnormal intensity ("developpement") of some phantasm: if that phantasm is of an action to be done, or of a motion, it will easily beget an insuperable impulse.

The praised physicians Pitres and Regis distinguish: a motor impulse, merely mechanical, which is often without affection, as for example in an idiot; a psycho-motor impulse, which is accompanied by a more distinct perception of the thing and a stronger commotion of the appetite; a psychic impulse: then the act does not always or necessarily occur; it is in the power of the agent to resist the impulse.

And so it is not easily discerned whether impulses were irresistible or not. They are to be judged such when the action cannot be explained by natural concupiscence. An invincible impulse also seems to be present if, after the evil action, the mind has remained quiet and content. But the matter is far more uncertain when the propensity is borne toward those things to which healthy men also are inclined.

Aboulia renders the will impotent for willing or for commanding efficaciously: either it remains idle, or, as if unwilling, it is forced to seek or flee certain things contrary to its own practical judgments. One who is affected by the former kind of infirmity is often excused from several positive duties. Concerning the latter, there return the things said about blind or invincible impulses.

Epilepsy, not that which is manifested by the customary phenomena of the comitial disease, but that which is called masked or hidden, impels one to perpetrate various strange, shameful, and atrocious things. It is clear that epileptic or hysterical agitation cannot be combined with grave guilt. But outside the times of frenzies, the mind becomes sane.

In the hypnotic state, insofar as someone is truly acted upon by another's command rather than himself acting, liberty also is taken away. In this state an artificial docility for believing, feeling, and doing those things which another affirms to be or orders to be done is induced in suitable persons.

And this excessive dependence on another often remains. Yet this can be avoided by a suggestion of liberty or independence added in the final command. There is also made a moderate suggestion conformable to the useful desire itself of the sick person, who, by this reason, may wish to be healed of certain less good propensities or to acquire a stronger will ¹.

¹ On this argument certain special treatises are usefully consulted, such as those written by R. P. Gemelli, O.M., in Italy, and Prof. Xavier Francotte, in Belgium. Cf. also L. Boone, S.J., Responsabilite normale et pathologique, Revue des Questions scientifiques, 1908; Les questions de responsabilite, Nouvelle Revue theologique, t. 42 (1910), p. 1 and following.

Neurasthenics can be excused rather easily when they yield to a certain weariness by which, as by an excessive burden, they neglect certain positive precepts, especially if these are merely ecclesiastical. Yet per se they are to be judged to sin if, because of sadness, they seek shameful delights to which the disease itself does not impel them.

N.B. Concerning the scrupulous, below, where conscience is treated.

¹ Since new ways of explanation are being attempted, meanwhile we set forth these things circumspectly.

91. Preliminary Note. From the intimate conjunction which exists between body and soul, it is easily understood that there also exists a most efficacious mutual influence between these two conjoined parts. The soul influences the body and the body influences the soul. A body well chastised serves the soul excellently, while on the contrary a rebellious body or one given to vices weighs down the soul. There is added the fact that, from original sin, lamentable disturbances have crept into the bodily powers, which indeed are still accustomed to be increased by atavism, that is, by a particular hereditary and native disposition transmitted by parents. All these things are established by daily experience and are denied by no one. But one must not proceed so far with several modern unbelievers that man's liberty and the imputability of actions are utterly denied, as if man had to act necessarily according to his native propensities and hereditary dispositions of the brain. For if this were so, then even the worst criminals would almost always have excuses for their crimes. For they could rightly say that they committed crimes not freely, but from a necessary hereditary disposition. They would not have to be punished, but pitied. These things indeed are false, and therefore in our times not only the liberty of man, but also the very great influence of the soul upon the body, notwithstanding native bodily propensity, is admitted even by some rationalist psychiatric physicians. For this reason those physicians are accustomed to employ so-called "suggestion," that is, moral persuasion in mental diseases; and, although rationalists, they acknowledge the beneficial influence of the priest-confessor in diseases of this kind. But on the other side it is of the greatest interest to the confessor to have some knowledge of these diseased states of the mind, and that for two reasons: 1. because of the utility of the penitent; for if the confessor judges rightly concerning the state of the penitent, he can assist him more efficaciously; 2. because of the utility of the confessor himself; for not rarely confessors ignorant of diseased states of this kind err dangerously, thinking with excessive credulity that all those things are objectively true which penitents narrate, for example, concerning miraculous visions had, diabolical invasions, etc. Hence arise the derisions of the malicious, disturbances of the faithful, detractions against the confessor himself, etc. - Since these things are so, we indicate certain brief rules concerning this matter, referring for a fuller doctrine to works which treat this matter expressly and which are accustomed to be called "pastoral medicine," "pastoral psychiatry," and by other similar names.¹¹⁵

¹¹⁵ Cf. Surbled, La morale dans ses rapports avec la médecine et l'hygiène, ed. 10, Paris 1905. A. Römer, Psychiatrie und Seelsorge (Berlin 1899). This author is indeed of the Protestant religion, but treats this matter excellently. S. Weber, Zwangsgedanken und Zwangszustände in pastoral-psychiatrischer Beurteilung (Paderborn 1903). Jos. Antonelli, Medicina pastoralis, ed. 3 (Rome 1906). Ig. Familler, Pastoral-Psychiatrie (Freiburg 1898). Raymond O.P., Le guide des nerveux et des scrupuleux (Paris 1911). Bergmann, Die Seelenleiden der Nervösen (Freiburg i. Br. 1923). Gemelli O.M., Skrupulosität und Psychasthenie (Regensburg 1915). Pierre Janet, La médecine psychologique (Paris 1923). Eymieu, Le gouvernement de soi même (Paris 1910).

92. Rule 1. In extraordinary and portentous facts supernatural or diabolical powers are never to be supposed, unless they have first been proved with moral certitude. If even the least doubt remains after investigation has been made, the effects produced must be ascribed to natural powers.

Otherwise the greatest illusions and grave inconveniences would certainly arise. Hence the phenomena of somnambulism, telepathy, etc., are not ordinarily to be proclaimed as diabolical effects, since it is not certainly established that they cannot be produced either by natural powers or by the most cunning craftiness of men. Nevertheless from this it is not lawful to conclude that any Christian whatever can licitly be present at societies or circles in which such phenomena are shown. For not rarely grave dangers against religion and good morals arise from this.¹¹⁶

¹¹⁶ Cf. below, on superstition (II, n. 520 sqq.), where this matter will be treated more broadly and where decisions of the Holy See against spiritism and magnetism will also be brought forward.

93. Rule 2. The voluntary and the free can be taken away not only in perfect insanity, but also in hypnotism and in certain pathological states of the mind. But if there is doubt whether an act committed in states of this kind is voluntary and free or not: in evil works (in odiosis) it is to be held as involuntary or at least as not a grave sin; but in favorable matters what has been done is considered to have been rightly done.

All admit that the voluntary is taken away in perfect insanity; experience establishes that the voluntary is also taken away in hypnotism (at least sometimes); for a hypnotized person sometimes does those things which outside the state of hypnotism he certainly would never do. In other pathological states of the mind experience likewise establishes that the voluntary is sometimes taken away, as is plain, for example, during epilepsy, during melancholia, which sometimes causes the so-called abulia or incapacity of willing efficaciously, during hallucination, and in some phenomena of hysteria. But in doubt concerning the liberty of an objectively evil act, it is not imputed morally as a grave sin, because no one is considered evil unless he is proved so. Moreover, in these cases grave voluntary malice cannot be proved. Hence the confessor must be a very mild judge in circumstances of this kind. But if there is question of a good act doubtfully voluntary and free, nothing prevents it from being presumed to have been done freely and voluntarily until the contrary is proved.

94. Rule 3. The voluntary, if it is not totally taken away, nevertheless is certainly greatly diminished in diverse and many diseased conditions of the nerves, among which above all are to be enumerated the so-called obsessions, fixed ideas (Zwangsvorstellungen), and hysteria.

95. Fixed ideas¹¹⁷ or obsessions greatly torment many men otherwise of sound mind, and they are concerned with almost infinite matters, so that up to this day they have not yet been able to be reduced by expert physicians to determined categories. For example, one man has a fixed idea that he must wash his hands almost a hundred times in a day; another in all things, even most holy things, always sees obscene things; a third labors under the fixed idea that he is utterly unable to pass through a vast place (agoraphobia, Platzangst), and so on. Experience shows that fixed ideas vanish completely for a time and appear again after an interval more or less long. What the causes of fixed ideas are is not yet certainly known. It seems likely that they are caused sometimes from hereditary disposition, sometimes from certain transmutations of the brain, sometimes from neurasthenia, and very often from vehement fear suffered; wherefore they also are accustomed to be called phobias. Fixed ideas greatly diminish the voluntary, so that scarcely, and indeed scarcely at all, can there be mortal sin in them. At most there is venial sin, and sometimes there is no sin.

Against fixed ideas there is no more efficacious means than (besides wise care of bodily health) strict obedience toward a prudent, strong, and especially patient confessor or director. For from such obedience and from the personal influence of the confessor, fixed ideas, if they do not entirely cease, at least leave life more tolerable, which otherwise can scarcely be borne. In time past fixed ideas were sometimes removed by physicians with the aid of hypnotism; but today's practice now less frequently employs hypnotism because of the inconveniences sometimes following from it, but rather has recourse to so-called psychotherapy or moral persuasions, which hardly anyone can perform better than a well-instructed confessor. Above all, however, the confessor should then strive to conciliate to himself the perfect trust of the one who labors under fixed ideas. Let him say to him that there is no great danger of sinning in these phantasms and obsessions; let him induce him to light labor which distracts the mind to other thoughts; but let him never say sharply: You are mad! your ideas are absurdities and follies, or other similar harsh words. But let him strongly, and at the same time bravely and sweetly, admonish him to patience; let him command him not to do anything unusual, for example, unusual exercises of piety, nor to go to other persons for asking counsel, nor especially to read books treating of temptations, disturbances of the nerves, fixed ideas, etc. For experience establishes that by the reading of such books fixed ideas are not only not cured, but rather are confirmed or transformed into other worse ones. - The confessor should also be very cautious concerning the so-called psychoanalysis invented by Freud and developed by others, since from psychoanalytic attempts there not rarely arise very baneful effects.

¹¹⁷ Cf. Familler, Pastoral-Psychiatrie 21; A. Ziehen, Psychiatrie (Berlin 1894) 120 sqq. Terminology in this matter is by no means uniform among diverse authors. As much as suffices for our purpose, under fixed ideas we comprehend all the things which by others are called: phobias, obsessions, psychasthenia, lucid dementia, etc. For in all these states this is common, that a man, however much he knows that this idea or impulsion is not sufficiently founded, nevertheless is unable to expel it.

96. Hysteria, if you look at the name (ὑστέρα), is a woman's infirmity, but today this name is used to signify a special disease of the nerves, which is found both in women and in men. Nevertheless it must be admitted that hysteria is found more often in females than in men;¹¹⁸ perhaps for this reason, because the nervous system in men is firmer than in women. First of all it must be observed that this disease is by no means always something shameful, nor does it always arise from lust. For experience establishes that most pious men and women sometimes labor under hysterical disease. Nevertheless it has also been discovered that those who labor under hysteria suffer temptations against chastity more easily and more vehemently. For when their nervous system is disturbed, and notably the genital nerves, then their will is weakened. What the cause of hysteria is, or what it itself is, still lies hidden from us. It seems to be at least principally a morbid autosuggestion which is also called pythiatismus (Babinski). Perhaps it is not an organic disease, but a functional one, as physicians say; that is, hysteria does not cause organic lesions, but more or less impedes physiological or psychological functions. The symptoms of hysteria are almost infinite and always variable, so that someone has rightly said that "in hysteria nothing is constant except its inconstancy." Yet this is established among all, that right judgment, the moral sense, and the voluntary are greatly diminished by hysteria. Let the confessor act with the greatest prudence and caution with persons laboring under hysteria, because otherwise both he himself and they will easily suffer great harms.¹¹⁹ Since it is not so easy to discern whether the disease of hysteria is truly present, it is worth the labor to bring forward here certain characteristic signs of this state, which are called the stigmata of hysteria:¹²⁰

1. Egoism altogether exaggerated and morbid. The hysterical person is accustomed to refer everything to himself or herself. Therefore such a person continually complains that other people do not sufficiently consider him or offend him with many kinds of things, which in reality are futile. From this the person also tries to make others pity him. He feels great satisfaction if other people acknowledge or admire his pains, anxieties, labors. But if others seem to neglect him, then with all his powers, even by exaggerations and lies, he thrusts himself and his state upon them. He does not care for his neighbor except because of egoism. Hence he also often offends his neighbor, not indeed by grave deeds, but as if by needle-pricks, so that those dwelling with him or often conversing with him must tolerate many inconveniences. In one word: the hysterical person, whatever he does, whatever he suffers, refers everything to his own honor or utility or satisfaction. He does not shrink even from tolerating great pains, provided that he is acknowledged by others as another Job.

2. Abnormal inconstancy¹²¹ in affections, and those very vehement, is the second characteristic sign of hysteria. The hysterical person now exults with jubilation of mind, afterward because of futile reasons is saddened unto death;¹²² today with great trust he approaches the confessor or physician and observes their commands most faithfully, tomorrow he complains about the confessor and physician as about men without heart and intelligence.

3. Defect of truth and veracity (pseudologia phantastica or mythomania) is the third, and indeed the saddest and most dangerous, quality of hysteria. This defect manifests itself both in actions and in words. The hysterical person deceives himself, deceives others, although he does not always do this knowingly or from malice. Hence in such a person there are sometimes found actions which, considered at first sight, appear miraculous, for example, heavenly visions, diabolical apparitions, fasting prolonged for several weeks (while secretly the person eats), indeed even bloody stigmata in the hands, feet, and side. Not rarely also the hysterical person narrates foul lies concerning the things and deeds of others, indeed very badly blackens the honor of the confessor and causes him many inconveniences.

4. Sins against temperance not customary are also sometimes a sign of hysteria. We have already said above that hysterical disease does not always arise from excesses of lust, as some falsely think; nevertheless experience establishes that hysteria easily leads to inordinate carnal delectations, and indeed with almost equal intensity to inordinate delectations of foods and drink as to venereal delectations. Hence hysterical persons often commit excesses in Venus and Bacchus. These phenomena are spontaneously understood if it is observed that the moral judgment of the hysterical person is clouded because of the person's exaggerated sensitive appetite. This disease can be aggravated to such a point that a person otherwise modest casts aside every shame and openly tempts, indeed even compels, other persons to immodesty. Since, moreover, the person affected by this disease has suffered a defect in the truth of judgment and in the veracity of speech, not rarely he falsely accuses others of lust committed with him. For this reason let a priest outside confession not speak alone with a woman alone, so that calumny cannot afterward be made against him. Alas! not one innocent priest, because of his imprudence, has in this way been falsely accused and condemned.

¹¹⁸ Cf. A. Aub, Die Hysterie des Mannes, Munich 1911.

¹¹⁹ Cf. Capellmann-Bergmann, Pastoralmedizin 10, 122: "In general, the greatest caution and reserve are to be recommended to the cleric in dealing with hysterical persons." Familler, l. c. 67 sqq.; Ziehen, l. c. 243 sqq.

¹²⁰ We omit merely bodily stigmata, as, for example, defect of the conjunctival, pharyngeal reflex, etc.

¹²¹ Great lability of representations and moods.

¹²² "Jubilant to the heavens, saddened unto death," the so-called laughing-weeping. Cf. Surbled, l. c. t. IV, cap. 4.

97. Morality of acts committed in hysteria. Acts committed by a hysterical person cannot be said to be utterly involuntary, except rather rarely, namely, when the absence of cognition and volition is established; nevertheless they must be considered imperfectly voluntary and consequently judged more mildly in the confessional. Therefore it often happens that an act committed by a hysterical person is not a mortal sin, which, if it had been committed by a healthy person, would without any doubt be grave fault. And this must especially be attended to in impure thoughts and desires, indeed sometimes even in external shameful acts.

98. Cure of hysterical disease. Some remedies must be sought from medical art, others from moral theology. It is indeed established among all that hysteria not rarely takes its origin from disease of the nerves and other bodily indispositions. Therefore first, with the aid of an expert physician, the bodily disease, if any exists, must be removed. Yet an organic bodily disease cannot always be found among hysterical persons. Then the confessor or priest should first of all strive to procure for himself the complete confidence and obedience of the hysterical person; and this indeed is a matter by no means easy. But when these have been obtained, with all prudence, all patience, and all firmness, let him endeavor that the abnormal egoism of the hysterical person be wiped away; let him suggest honest distractions and delectations; let him not permit excessive exercises of piety and mortification; but let him prescribe above all works of mercy and charity toward one's neighbor. By this manner of living and acting, hysteria will gradually cease or at least will become more tolerable.

The subject of the present lecture, gentlemen, is “Insanity.”

I. This subject belongs to a course of Medical Jurisprudence, because a physician who treats patients for insanity is liable, from time to time, to be cited before a court of law either as a witness or as an expert. His conduct in such cases is to be guided by the principles of natural and legal justice.

Various important cases at law turn upon the question of a person’s soundness of mind; and frequently the medical expert has it in his power to furnish the court with more reliable information in this matter than any one else. At one time, the validity of a last will may be contested, and the possession of a fortune by one party or another may hinge on the question whether the testator at the time of making his will was in sufficient possession of his mental powers to perform an act of so much consequence.

At another time, interested parties may plead for or against the validity of a sale or other bargain made by a person of doubtful competency of mind; or a life-insurance company may be interested in ascertaining the mental condition of an applicant for membership; or it may be questioned whether the payment of an insurance policy is due to the family of a suicide, the doubt depending for solution on the sound or unsound condition of his mind at the moment of the fatal act. Again, there may be a real or pretended doubt whether a certain property-owner is so far demented as to be unfit to manage his estate; or whether he needs a guardian to take care of his person; or it may even seem necessary to confine him in a lunatic asylum. There may be objections raised to the mental soundness of a witness in a civil or a criminal suit; or, finally, a criminal prosecution will depend mainly on the sanity or insanity of the culprit at the moment when the crime was committed; as was the case with a Prendergast and a Guiteau.

You see, then, gentlemen, that important interests are dependent on the thorough and correct understanding of this matter; and therefore much responsibility rests upon the experts consulted in such cases: property, honor, liberty, nay, even life itself may be at stake.

That cases involving an insane condition of mind must be of frequent occurrence, both in the medical and in the legal professions, is apparent from the large and rapidly increasing amount of lunacy in our modern civilization. Wharton and Stillé’s “Medical Jurisprudence” states (sec. 770, note) that in 1850 there was in Great Britain one lunatic to about one thousand persons; only thirty years later the Lunacy Commission of Great Britain reported one lunatic to 357 persons in England and Wales, that is, nearly three times as many. In New York there is one to 384 persons. It appears certain that its increase of late is out of all proportion to the increase of population; and even though I see reasons to distrust somewhat the figures quoted for England, enough is known to create serious alarm regarding the fruits of modern manners and customs on the minds of thousands. This fact makes the matter of insanity very important for the medical and the legal student.

II. Still it must be noted that the responsibility of deciding cases of lunacy does not rest chiefly with the medical expert. In cases of doubtful insanity the decision is to be given not by the Doctor but by the court of justice. Except on very special occasions, as when a physician is appointed on a committee or commission of inquiry, he appears before a court either as an ordinary witness, stating what facts have fallen under his personal observation; or as an expert, explaining the received opinion of medical men with regard to cases of a certain class. Even though he feels convinced that the culprit or the patient is as mad as a March hare, the physician cannot expect that his statement to that effect will be received as decisive. It is for the judge to instruct the jury what kind or degree of insanity will excuse a culprit from legal punishment, or will disqualify a person from testifying as a witness, or from being a party to a civil contract in certain cases; and it is for the jury to decide whether, in the case in hand, the fact of such insanity exists or not. In criminal cases, the jury pronounces on the double question, whether the accused did the act charged to him, and whether he has been juridically proved to have been accountable for the act under the laws as expounded by the judge.

1. To come to a decision on this double question, the jury might need to hear the facts stated which the physician has personally observed, and of which he is summoned to be a sworn witness. In such a situation all that is required of the Doctor is that he shall give a most faithful and intelligent account of the facts.

It would disgrace his standing in society if any fault could be found with his testimony; and, as a sworn witness, he is bound in conscience, like any other witness, to state the truth, the whole truth, and nothing but the truth. This is always the case when the purpose of the inquiry is the discovery of the sane or insane condition of a person’s mind. But if the inquiry concerns the performance of the guilty act, the commission of the crime, many States of the Union, as explained before, consider the Doctor’s professional secrets as privileged, just like those of the lawyer and the clergyman; i.e., the Doctor must not use against his patient any knowledge he has become possessed of while acting as his medical adviser.

2. When the physician appears before a court or commission as an expert, he is expected to give the views of the medical profession upon hypothetical cases resembling the one under examination, and the scientific reasons and authorities on which those views are advanced.

3. But here a considerable difficulty presents itself; it is so serious that, owing to it, the weight of the medical expert’s testimony with judge and jury is often much less than could reasonably be desired. The difficulty is to ascertain what really are the views of the medical profession on any given subject. Of course no individual Doctors can put themselves up as representing the convictions of the medical profession, nor can they always appeal to the unanimous agreement of their leading men. Leading physicians, unfortunately, are far from entertaining concordant views on many most vital questions. It is this want of agreement that has made the testimony of experts so powerless to sway the minds of judge and jury.

The medical profession has no organization through which it can pronounce judgment. In fact, many of its most conspicuous members have adopted principles at variance with the deepest convictions of mankind generally; such, for instance, are the followers of Darwin, Huxley, Maudsley, and similar agnostic and materialistic leaders of modern thought.

4. What still further diminishes the credit of medical experts is the fact that, both in civil and criminal trials, they are summoned either by the defence or by the prosecution, and are thus naturally selected, not on account of their thorough knowledge, but on account of their peculiar views known beforehand to the parties citing them. Thus their testimony is likely to be partial to either side, and is distrusted; at least it fails to command perfect confidence. The only way in which the prejudices thus created against the physician can be overcome is by his acquiring thorough knowledge of his specialty, and showing himself on all occasions to be as honorable and faithful as he is evidently experienced and intelligent.

5. The medical profession could be brought to be much more useful to society for the discovery of insanity if we could have here something like what exists in some parts of Germany. “The practice obtains there of requiring the medical faculty of each judicial district to appoint a special committee, to which questions of this kind are referred. This committee is examined directly by the court, and gives testimony somewhat in the same way, and with the same effect, as would a common-law court when reporting its judgment in a feigned issue from chancery, or as would assessors called upon under the canon law to state, in proceedings under the law, what is the secular law of the land on the pending question” (Wharton and Stillé, sec. 274).

The matter of introducing some such practice into this country has been agitated of late, and may by and by lead to beneficial results. Dr. Shrady has taken steps to promote this object by striving to have a law enacted by the New York legislature providing for the regulation of expert medical testimony in jury trials. According to his plan, once such a commission has been established, the court is to send the medical issue to these experts, just as it sends other issues to special juries to be decided. The regular petit jury will then decide only upon the facts constituting the crime.

This would do away with special pleas of insanity before a jury that knows little or nothing about the nature of the disease, and whose sympathies may readily be worked upon by shrewd lawyers to render a verdict of acquittal.

As things are now, the medical expert, summoned to testify in a case of contested sanity or insanity of mind, ought to rise above minor considerations, and promote the cause of justice, by giving all the valuable information that his profession enables him to acquire on the very difficult subject of mental unsoundness.

6. For this purpose, he must be skilled in three departments of science.

(a) In law—sufficiently to understand what are considered by the courts as characteristic marks of an insane mind, and what amount of sanity the courts require to hold a culprit responsible for his crime or a contract valid in its effects.

(b) In psychology—to such an extent that the expert witness can speak analytically and correctly as to the properties and actions of the human mind.

(c) In medicine—so far as concerns the treatment of the insane, and the understanding of their peculiarities, so as to reason from them by induction to the real condition of the client’s or patient’s mind.

But the main requisite for an expert witness is to understand clearly in what insanity properly consists, and how far it ought to excuse an insane man from bearing the consequences of his acts.

III. This two-fold knowledge is obtained by the psychological study of insanity, on which study we are now to enter, and it is the principal point in this whole matter.

Insanity means a want of soundness; he is insane whose mind is not sound, but is deranged, and therefore, like a machine out of order, it cannot properly perform its specific task, namely, to know the truth of things. An insane man cannot judge rightly.

1. Insanity takes various forms, which may be reduced to two kinds, with the doubtful addition of a third kind, namely, moral insanity, of which we shall speak in our next lecture.

The first kind consists in the total want or gross torpor of mental activity. When there is a total, or nearly total, eclipse of the intellect, the disease is called idiocy, the state of an idiot. When there is an abnormally low grade of the reasoning power, it is styled imbecility. The failure or decay of reason in old age is called dotage.

The second kind of insanity is called illusional or delusional. In it the intellect is not impotent; on the contrary, it is often unusually active; but its action is abnormal, its conclusions are false. Not that it reasons illogically or draws conclusions which are not contained in the premises. Very keen logicians may be demented. Their unsoundness arises from the fact that they reason from false premises; and they get their false premises from their diseased imaginations, whose vagaries they take for realities.

2. Here a difficulty presents itself, which we must explain at once, namely, how can there be unsoundness of mind at all? Is not the intellect of man a simple power, and his soul a simple being? How can a simple being become deranged? Can that which has no parts become disarranged, disorganized? I answer, the soul is a simple being, its intellect is a spiritual faculty; and therefore we never say that the soul is insane, nor should we say that the intellect is insane or diseased; but we say that the mind is deranged or insane; the mind comprises more than the intellect; it designates the intellect together with those lower powers that supply the materials for our thought, the chief of which is the imagination. Now the imagination is an organic faculty: it works in and by a bodily organism, which is the brain. Therefore, when the brain is not in a normal condition, the action of the imagination may be disordered. And the intellect or understanding of the spiritual soul is so closely united in its action and its very being with the organic body that the two ever act conjointly, like the two wheels of a vehicle. If one wheel breaks down, the other is thrown out of gear. Thus it is readily understood that mental unsoundness is an affection of the brain, a bodily disease, which may often be relieved and even cured by bodily remedies, by the use of drugs or wholesome food, healthy exercise, fresh air, and all that benefits the nervous system.

Pathologically considered, the nerves may be too excited or too sluggish and torpid; and we have as the result two subdivisions of mental insanity—mania and melancholia. The differences between these two are very striking; as they proceed from opposite causes they produce opposite effects, and, therefore, they betray themselves by very different manifestations; but in one point the two agree, and with this point precisely we are concerned, because in it lies the essence of mental insanity, namely, that both produce a disordered action of the imagination.

3. The manner in which the imagination co-operates in mental action is this. It presents to the intellect the materials from which that power forms its ideas. When we see, feel, hear, taste, or smell anything by our bodily senses, our imagination takes note of the object perceived by forming a brain-picture of it which is called a phantasm. I do not mean to say that it forms a photographic picture of the object; for there can be no photographing taste or smell or feeling; but it forms an image of some kind which it presents to the intellect. This power at once proceeds to form, not a brain-picture, but an intellectual or abstract image of the object presented. For instance, you see this book, and at once you, in some mysterious way which has never yet been explained, impress some image of it on your brain. That you do so is clear from the fact that the image remains when the book is withdrawn. That material image or brain-picture is the phantasm. It is not an idea, though it is often improperly so called. But your intellect forms to itself an idea of a book; that is, you know what is meant by a book. You distinguish between the mere form of a book and the book itself. Your idea of a book is a universal idea, which stands for any book, no matter of what shape or size. Every phantasm, or brain-picture, is a representation which presents its object as having a definite shape or size, while your idea of a book ignores any shape or size. And yet, when your intellect conceives a book, your imagination will picture some particular form of book. If your brain became so affected by disease as to be unfit for the formation and retention of the proper phantasms, then your intellect either would not work at all or it would work abnormally; your mind would then be insane.

4. Now, in an infant the brain is still too soft and imperfect to form the proper phantasms from which the intellect is to elaborate its ideas. A false school of psychology would say that the infant’s brain cannot yet ideate; but that is incorrect language. No brain can ideate or form ideas; an idea is an intellectual or mind image, not a brain image; it is an abstract and universal image, and matter cannot represent but what is concrete and individual. Only a simple and spiritual being, the rational soul, can form ideas. Nevertheless our soul, in its present state of substantial union with our body, is extrinsically dependent on the body; to form ideas it needs to have the sensible object presented to it by a phantasm or brain-picture. Now, a child born blind and deaf, and thus having its mind, as it were, cut off from communication with the outer world, could scarcely form the necessary phantasms, because the clogged senses could not supply proper materials for them; such a child would, therefore, be apt to remain idiotic. And even in children whose outer senses are sound the brain or the nervous system may be too imperfect to allow of its forming proper phantasms. In this torpor of the mind then consists the first kind of mental unsoundness, that of idiocy, or its milder form imbecility. In old age, and in peculiar diseases, the worn-out system may return to a second childhood, then called dementia or dotage. The existence of such species of insanity is not difficult to discover.

5. The second and more common form of insanity, and that which it is often difficult to discover and pronounce upon with certainty, is that which I have called delusional or illusional. Its characteristic trait, its very essence, lies in this, that the insane man mistakes what he imagines for what is real; and he cannot be made to distinguish between imagination and reality, though the difference is obvious to an intellect in its normal state.

In this connection, it is well to point out a distinction, not always observed, but useful to explain the workings of an insane mind, between illusions, hallucinations, and delusions.

(a) An illusion is properly a deception arising from a mistake in sense-perception; as when a half-drunken man sees two posts where there is only one. He has a picture of the post in each eye, and his brain is too much disturbed to refer the two pictures to the same object. In this case the cause of the mistake is subjective. A mirage offers another instance of a sense-illusion; but in it the cause is objective.

(b) A hallucination is a creation of the fancy mistaken for a reality. The deception may be but momentary, as when Macbeth is stealing on tiptoe to the chamber of his guest to murder him. His mind is disturbed by the imagination of the horrid deed he is about to perpetrate. He thinks he sees a dagger in the air, and he says: “Is this a dagger that I see before me, its handle towards my hand? Come, let me clutch thee. I hold thee not, and yet I see thee still; and on thy dudgeon gouts of blood, which was not so before.” But Macbeth, upon a moment’s reflection, sees it is all imagination. “There’s no such thing,” he exclaims. He is not insane, though deceived for a while.

(c) A delusion, on the contrary, is a permanent deception, whether it results from an illusion or a hallucination, it matters not; as a fact, it almost always originates in hallucinations. The deluded man clings to his imaginings; you cannot talk them out of his head. Such is the case of an inebriate who suffers from mania a potu, or “the horrors;” he sees snakes and demons, he thinks, and persists in his error. Such also is a fixed idea not arrived at by faulty reasoning, but come unbidden and proof against all reasoning and evidence. Thus an insane man may be convinced, solely by his imagination, that he is poisoned or pursued or conspired against.

6. This delusion constitutes the essence of mental insanity, which therefore is often called delusional insanity. It may be chronic, i.e., of long continuance, or it may be temporary, acute. For the time being, the effects are the same. Perhaps any man may, at times, be for a moment thrown off his guard, and mistake a fancy for a reality; this does not constitute lunacy. But when the error is so firmly held in the mind’s grasp that nothing can dislodge it thence, then the mind is deranged in its special sphere of action, which consists in knowing the real from the unreal; the mind is then insane.

You notice, gentlemen, that I speak of the mind as grasping the error, and I suppose it to do so independently of the free will’s command. But when the error is voluntary; when a man clings to it simply because he loves it; when he hugs a delusion to his heart, this shows not mental but moral obliquity; it is not insanity but self-deception, and it is by no means of rare occurrence. In a well-reasoned article on “The Metaphysics of Insanity,” written by Mr. James M. Wilcox and printed in the “American Catholic Quarterly Review” for January, 1878, some very severe and no less true strictures are made upon the readiness of a vast multitude of people to practise this wilful self-deception. “Self,” he writes (p. 54), “is the prolific origin of such errors; and so indulgent are we to its faults that we try secretly to hide them even from our own eyes, mostly with success; and where success is not perfect, we make a second effort to hide the imperfection. Repeated efforts of this kind, from which we but half turn away, are crowned in the end, and we soon forget what successful hypocrites we have been. Our numerous passions, the complexities of our desires, the tenacity of their grasp, and the pleasant gentleness of its touch explain an infinity of temptations followed by wilful successes in blindness, all of which are nothing less than guilty acts of self-deception.”

7. It oftens[**] happens in real insanity that mental derangement manifests itself upon one error or one group of errors only, while for all the rest the patient appears to be quite rational. Such a man is called a monomaniac. But he is truly an insane man; for the essence of insanity is in him. It is usually found that a monomaniac will, sooner or later, exhibit signs of mental unsoundness on other matters as well; and even while he has given no such signs, it still remains true that a mind cannot be trusted, but has something radically unsound about it, if it is really unhinged at any point at all.

But then you must be very careful not to confound monomania with eccentricity. The distinction is as important as it is real. Eccentricity is a conscious aberration from the common course of life; it consists in peculiarities in reasoning, words, and actions, which are wilfully indulged, in defiance of popular sentiment. The eccentric man knows that he is eccentric; he is willing to be so, and to take the consequences; but he is not insane.

1. Theologians are not accustomed to hand down many things about these; the principal things which we set forth here are taken from Vermeersch, Prummer, Tanquerey, Damen, and Wouters.

98. Bodily constitution, which can depend much upon heredity and undergoes change from education, can be enumerated first among the causes which more remotely influence freedom.

1. Bodily constitution (temperament) is the complex of those propensities which belong to each one from his own organism and constitute his special character; but since native dispositions of this sort can in some way be changed by one's own efforts, by education, and by external circumstances, character is called the complex of native propensities insofar as they have been changed by one's own will and by the instruction of others and have acquired some firmness. Hence St. Thomas (Contra Gentiles II, 63): "The soul rules the body and resists the passions which follow the bodily constitution: for from bodily constitution some are more apt than others for concupiscences or angers; yet they abstain from these more, on account of something restraining them, as is clear in the continent." Accordingly bodily constitution diminishes the exercise of free choice, but does not remove it; as was said of the passions and habits of which it is the cause. This, moreover, is established by one's own experience and that of others.

2. The constitution of the body depends much upon heredity, by which propensities that depend more upon the organism are transmitted from parents into children, and indeed not only physical defects or bodily or sensible qualities, but also mental aptitudes, even moral propensities such as inclinations to anger, drunkenness, sins of the flesh, suicide, so that in very many regions examples are alleged of families in which certain virtues or vices have been transmitted through many generations.

Now, although sometimes from vicious parents a certain species of madness can be transmitted which entirely removes liberty, ordinarily nevertheless the use of reason and of liberty remains. Against modern determinists, who contend that by the law of heredity the liberty of children is destroyed, into whom propensities are transmitted without their consent, it must be held that by hereditary propensities free choice is diminished, insofar as by them reason is clouded and the force of the will is in some way weakened, as we have said about passions and habits, to which hereditary inclinations can give rise and therefore can be assimilated. Nor is there only an influence of the body upon the soul; but conversely there is also an influence of the soul upon the body.

3. Natural propensities which arise from bodily constitution or heredity, and are strengthened by character, are much increased and diminished by education. Education influences free choice in three ways: by inculcating principles, whether good or evil, which easily turn into prejudices, or by omitting to inculcate good principles; by providing examples by which the intellect is indirectly led little by little to approve that which is done by many, or even the will is directly drawn to consent; finally, by exciting the passions and directing them to good or evil (for example, by counsels or the reading of books). Now with regard to inculcated principles, the things we said about ignorance must be applied, for ignorance does not always render a thing involuntary simply, if that ignorance is consequent; but with regard to examples and excited passions, the things handed down about passions have force, for they generally do not remove liberty but diminish it.

99. Another cause is pathological states or diseases of the mind, which are so called, not because the soul itself or the spiritual faculties can be sick in themselves, but because, on account of badly affected organs, especially the centers of the brain, and on account of the organic sensitive powers, they are impeded in their action, either transitorily or permanently. Some are merely functional, without lesion of an organ, and are called psychic; others are organic, with lesion of an organ, and are called physio-psychological. They are distinguished:

1. These things are not altogether according to the most recent determinations of the sciences. We have not wished to declare the diverse and manifold terms which they use and new classifications, as being indications sufficiently useless for our purpose. Exposition according to the natural sciences is to be held in great esteem in moral doctrine if it contributes to the elucidation of the matter and to establishing practice; otherwise it is rather to be left aside as useless or even as adding difficulty. Besides, the sense of terms is not the same among all, to which indeed attention must be given lest they be wrongly understood.

A. Psychoses, which habitually disturb the use of reason, at least in a determinate matter, so that the sick are not conscious of their abnormal state. Thus:

1. Dementia, which is a growing weakness and dullness of mind.

2. Phrenesis, of which various species are counted. In it the sick bring forth false judgments which 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 dreamers.

Hence in delirium, even if it is monomania or a hallucination restricted to one subject, they are not free; during the intervals of deliriums nothing of itself impedes liberty.

B. Psychasthenias, which impede practical judgment and the will, but in such a way that the infirm are conscious of their abnormal state and psychic weakness. And indeed:

1. Obsession occupies the mind in such a way that the obsessed person is bound to thinking about or doing certain things. It disturbs practical judgment sufficiently, so that, if it is vehement, often only room for light fault is left, and grave sin can hardly be present in them. But besides perpetual obsessions, there are others which arise only in certain circumstances; hence outside the state of obsession the infirm are bound by the precept of fleeing occasions of morbid excitation toward committing dishonorable acts, and if they freely violate this, they are guilty.

Phobias, fixed ideas, more intense scruples are reduced to obsession.

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

2. Blind impulses or invincible propensities can be present in a morbid state, whether they immediately obtain a non-deliberate act, or overcome vain resistance so that the act is nevertheless elicited. Hence some are merely mechanical or motive, which often are without affection, as for example in an idiot; others are psycho-mechanical or even merely psychic, which occur with a more distinct perception and a stronger affection, and often leave partial liberty.

All suppose a suggestible person, for his passive docility depends upon the intensity of a certain phantasm which rather easily produces an insuperable movement. 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, or pyromania; yet these are not to be confused with 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 impulses are truly irresistible, but it must be judged from all the circumstances whether liberty is only diminished or removed. The latter can easily be supposed a) if the action cannot be explained by natural concupiscence, b) if after the evil action the mind has remained quiet and content, c) if something is done which otherwise someone wholly abhors; nevertheless liberty is not always removed. Whence the things we said above concerning violence, fear, and concupiscence can be applied.

3. Abulia renders the will impotent for willing and for effectively commanding what is desired, whether it remains idle, or, as though unwilling, is compelled contrary to its own practical judgments to do or omit certain things. In the first case, the infirm person is often excused from certain positive duties, because liberty is at least sufficiently diminished; in the second case the things said about impulses have force.

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

C. Psychoneuroses or disorders of the nervous system itself:

1. Neurasthenia is a pathological state consisting in habitual fatigue of the nervous system from an organic or psychic cause; in this state the nerves appear weakened and exhausted, so that the agent, although in possession of himself, suffers from the greatest inconstancy and is much depressed physically and morally. Therefore liberty is diminished, though it is not removed. Hence the infirm can rather easily be excused when, yielding to weariness, they neglect certain positive precepts, especially those that are merely ecclesiastical, as too great a burden. But if, because of sadness, they seek shameful pleasures to which the disease itself does not impel them, they are to be judged as sinning in themselves.

2. Hysteria, although men dispute about its cause, also brings with it a disorder and disturbance of the nervous system, but much graver than neurasthenia, which consists in a great 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 bodily movements more or less disordered, as well as vivid hallucinations or vehement passions which are very unstable and greatly impede the free exercise of the will, just as they impede right judgment and the moral sense. Therefore hysterical persons easily deceive themselves and others. Hence in practice, only from circumstances and from the declarations of the hysterical persons themselves can it be known how much liberty remains in them. A hysterical agitation (crise, acces de grande hysterie) cannot be combined with full responsibility and grave guilt.

3. Epilepsy is still graver, that masked or hidden form which impels one to perpetrate various strange, shameful, and atrocious things: to inflict injury, blasphemies, shameful conversations, assault, homicide, etc.; not indeed constantly, but with longer intervals interposed, without the infirm person retaining the memory of all these things. An epileptic agitation or crisis certainly cannot be combined with full responsibility and grave guilt. But outside the times of fury the mind is sound and perfectly free, unless sometimes a transitory psychic disturbance is added.

All the aforesaid disturbances, even if they affect emotion or will, seem to draw their origin from a clouding or diminution of intellectual cognition.

1. Conformably to St. Thomas, I-II, q. 10, a. 1: "insofar as reason remains free and not subject to passion, so far the movement of the will which remains does not tend of necessity to that to which passion inclines."

Therefore, in a general view, as to pathological states, "cases in which imputability remains whole, or in which it is altogether removed, come to be considered as exceptions. For generally imputability neither remains intact, nor is it altogether removed, but is diminished.

This proposition regards acts which proceed from abnormality, and does not regard acts which are placed outside the influence of abnormality, for example, concerning other matters or in lucid intervals; ... moreover it regards actual imputability, and intends to prejudice nothing concerning indirect imputability or imputability in the cause, both as to the abnormality itself and as to the effects of abnormality. But this imputability cannot be neglected.

Even in practice, for example in direction, although one must proceed gently, this imputability is not to be too much diminished by excuses...

As to care, once the state of those laboring under abnormalities has been inspected, the role of priest, physician, friends, and family, and the collaboration of all these, must be determined. As to this collaboration, care should be taken lest the confidence of the sick person in one of the indicated persons harm the confidence which the infirm person ought especially to have toward the priest and physician. On the contrary, it is to be desired that, for example, friends in whom the sick person confides, take pains, insofar as can be done, that confidence in the physician and priest always increase.

Care should also be taken lest there be opposing "remedies" (counsels, suggestions, etc.), so that their action would be mutually weakened or practically have no efficacy. And therefore, by questioning the physician or the family or prudently the sick person himself, the priest should know, insofar as can be done, what the physician has thought and determined. Friends and family also should have suitable indications. Thus all, in a positive and best way, can work toward healing."

2. Theol. Mechl., Tractatus de Actibus humanis, 5th ed., edited by H. De Mesmaecker, n. 41.

100. The third cause is hypnotic sleep. This a) in the perfect or deep state greatly diminishes the exercise of liberty, indeed, as long as it lasts, almost removes it, except perhaps with regard to things to which the person is wholly opposed; b) in the imperfect state of lighter sleep, liberty is diminished; c) with regard to suggestions, however, to be fulfilled afterward in the waking state, the matter is disputed: for the Nancy school contends that the hypnotized person, even in this case, cannot morally resist the suggestion, while the Paris school asserts that liberty is not entirely removed but only diminished.

In practice, therefore, the hypnotized person must be questioned carefully and cautiously so that, from his own testimony, it can be discerned whether and how far he was in some measure free in performing the action. Yet actions which are perpetrated in hypnosis can be free in the cause, when he freely abdicated his will and gave consent to hypnotic sleep, foreseeing that actions of this sort would be suggested or exposing himself to this danger.

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;