Aspects By IAN
of Character Defect
concerned with Mental Deficiency as a social problem the point that in assessing the degree of defectiveness, and in deciding the form of care or treatment to be applied, greater importance ought to be attached to the ability of the defective to adapt himself to his social environment than to any formalised set of intelligence or perThose who
The Law, however, lays not a little stress on " Mental Defectiveness " ln the limited sense of intellectual defectiveness. Thus, even in cases where there is clear clinical evidence of antisocial behaviour dependent upon some form of mental defectiveness?in the wider sense of incomplete mental practitioners and committing authorities usually require evidence as to intellectual failure before they will take active steps. Any person, who is mentally deficient in the medical sense of the term but who may nevertheless have an intelligence quotient of more than about 70, has little hope of receiving, under proper legal control and safeguard, the treatment which he may require, unless his social inadaptability is extremely gross. A plausible manner, coupled with an intellectual level of about 12 to 14 years, is often a sufficient offset to persistent lying, stealing, sex offences, "
settle down in any occupation, to prevent these pathological states from being treated as such; and the unfortunate subjects of them may find themselves dealt with as criminals rather than as sick persons. Per contra, if any attempt is made?especially if it be against the wishes of parents or other near relations?to provide institutional treatment or even statutory supervision before the onset of the graver forms of antisocial behaviour, the probability is that public opinion immediately becomes violently censorious. It is rare, however, to hear quite so much about the same case when some grossly offensive act is committed subsequently; unless it be a mild trouncing of authority for allowing such criminally inclined persons to be at large. Public opinion, when moved to righteous indignation, is never quite so righteously indignant about sins of omission as it is about sins of commission. Clearly then, it is not only much easier, but it is infinitely less hazardous to do nothing about these difficult high grade defectives than to attempt to deal with them; and that is what, with bland and impersonal indifference, is being done in many places to-day. But not in all, for there are sporadically and in very small numbers up and down the country centres, clinics and institutes where a genuine?and be it marked, voluntary?attempt is made, often in the face of very great difficulties, to cope with this particularly exacting group of patients. This group falls as it were between two official stools; for the patients in it are not moral defectives within the meaning of the Act; and they are not suffering from any recognisable frank psychosis or psychoneurosis. Yet they are undoubtedly in a state of mental ill health.
A girl of twenty, the daughter of a professional man, and a personable, plausible, not unattractive girl at that, persuades her mother to buy her a new frock, which she immediately destroys by fire to spite mother." She writes mischievous letters to friends of the family with a view to pretending that she is ill-treated. "
A boy of seventeen, with an Intelligence Quotient of 90, commits almost every known petty crime in the calendar, from larceny to indecent exposure?apparently without reasonable motive, and in spite of punishment?knowing full well that he is doing wrong.
A young alcoholic and
of good family and education, already something of an suffering from Venereal Disease at the age of twenty-three, repeatedly makes unauthorised joy-rides in motor cars and drives them in a reckless manner resulting in two major accidents, for the first of which he served a term of imprisonment. He is unable to apply himself for more than a few months to any one of the half-dozen jobs that have been found for him by his influential Father. man
one of these cases showed intellectual defect on Binet Standards, of these fulfilled the clinical criterion of any recognised psychosis or psychoneurosis, not one of them had a reasonable motive for such conduct, but they all had one feature in common; they were unable to apply them-
of time; to any task with reasonable assiduity for a reasonable period and it is this shiftlessness, this lack of singleness of purpose, this inability to apply oneself, which is the clinical criterion of the group. The name which we give them matters but little, we may call them behaviour problems and so forth, constitutional
psychopathic personalities, underlying process? Clinical experience leads me to believe that the shiftlessness, the incapability of sustained effort, the inability to make use of the emotions and the intellect for adaptative purpose is, in popular and rather misleading language, a failure or distortion of development of the will. Let not the but what is the
hedonists and determinists raise their hands in horror, for I suggest a return to the old faculty psychology." " If we consider character in the sense in which McDougall uses the Word?that is, the integration and organisation of the higher acquired sentiments?and bear in mind all that he implies in its development?" Will power is character in action "?surely it is proper to regard these conditions as character-defect states, due to a failure of higher emotional development. Do not let it be thought that these patients are necessarily without will power"; on the contrary a blind stubbornness in the face of organised authority is often one of their most characteristic marks. Just as the straightforward intellectual defective sometimes shows queer, unbalanced ability to perform acts of intellectual prowess (the idiot-savant type) so, in the emotional sphere, we find persons generally defective in the higher development of their emotional functions (e.g., the personal and moral sentiments), showing unbalanced jutting out of one or more of the cardinal emotional patterns, of which stubbornness is probably the most irritating and certainly the most |ntractable from the therapeutic point of view. There is a regrettable tendency, in places where they ought to know better, to regard stubbornness in adolescents as evidence of the existence of those sterling qualities which go to make the bulldog breed." But this stubbornness of which I speak is unreasoning stubbornness; complete unwillingness to listen to, let alone acknowledge the other man's point of view; and defeat, whether at the physical level of fisticuffs, or at the mental level of reasoned argument, is inevitably accompanied by a scene," an exhibition of bad temper, or a mulish and ill-mannered silence; never, by any chance, is defeat gracefully acknowledged: dignity ls not an attribute of this group. with an this type of stubbornness is associated Characteristically, are easily exaggerated degree of facility in other directions. Such persons led; in spite of good homes they have a genius for picking undesirable friends and following their ways. According to their social levels they may become the associates of street bookmakers, public-house touts and women of the of streets, or in a superficially different but fundamentally similar stratum more the showy types society they fall into the hands of expensive gamblers, of places of entertainment and eventually of the Official Receiver.
There then, are the clinical criteria of a clearly defined form of character defect; inability to apply oneself: unreasoning stubbornness towards authority "
for being easily led by the wrong kind of people. What is to be done about it? An earlier, and possibly wiser if less humane-and-social-improvementminded generation simply regarded these people as ne'er-do-wells; and accordfamilies they became vagrants, habitual criminals, ing to the means of their " remittance men." Organised society, in fact, solved chronic insolvents or the problem as cheaply as it could on the general principle of get rid of in transition fail to cannot them." We are at present a stage. Psychiatrists in the medical of a form of ill-health mental sense, recognise the existence, in these people, but to formulate this, in legal terms has not yet been shown to be either possible or desirable. Clearly education of the public mind is the first desideratum; but the medium through which this should be achieved The less such education smacks of intellectualised is open to question. officialdom the better; and one cannot help feeling that guidance by family physicians might be a big factor in bringing about earlier recognition of these states for what they are. The next step is the administrative machinery. To envisage the needs of the country being put on a purely voluntary basis (in the financial as well as the legal sense) is but an empty dream. Local Authorities would have to be brought into it: but that need not debar the patients or the rate-payers from the advantages of voluntary co-operation on the clinical side of a few (very few of this group, I fear) patients and their relatives; and on the financial side of voluntary associations and helpers. I do not profess to assess the numerical incidence of these character defect cases in relation to size of population. There are no official statistics to guide us, for these cases are not ascertainable as defectives, and seldom certified as of unsound mind; but out-patient practice in three large industrial towns leads me to the conclusion that here is a clinical group, a misery to themselves, a source of anxiety to their relatives and not infrequently a danger to the community, for whom the present administrative machinery does not provide. Assuming such machinery to exist?and it is, of course, open to argument whether it is desirable to mechanise the practice of medicine any further?what can be done by way of treatment for such cases? " The answer, unfortunately, is very little." Apart from the remote of a biochemical attack possibility upon the endocrine gland functions, these cases do not lend themselves to treatment, for very lack of desire to co-operate with the physician. In any case they are not suitable for analytical psychotherapy, because they lack the necessary organisation of the sentiments to effect a transference; and even if this could be achieved, they would not be able to sublimate at a useful social level, for the same reason. Punishment only makes them worse; and with a well defined case the only course at present open to us is rational persuasion applied with infinite patience, while the patient remains under some form of Social Guardianship.
of character defect states is a faulty organisation acquired higher sentiments, the keynote to their eradication is education during the impressionable years of early childhood. This is not to be conceived as being a plea for bureaucratic interference in family life; but I do suggest that the family physician, were he better instructed in psychiatry than is at present considered necessary?and always assuming that he is not, within the next generation, driven out of existence by the march of well intentioned but badly executed efforts to provide more rare and refreshing fruit?might well be in a position to give something more than a timely hint to parents on the psychological upbringing of their as
we come back as in so many other psychiatric the education of the general practitioner in psychological rnedicine. At present these cases are not even suspected, let alone diagnosed correctly, until something fairly gross happens, or until there is a string of disquieting minor incidents over a period of years, by which time the fundamental faulty emotional patterns have become almost a conditional reflex and quite inaccessible to treatment. The Child Guidance clinic may offer some help, but, in the limited group of which I speak, it is not in a position to offer much; for one thing cases arc not referred until well advanced, and, for another, contact-with-the-home however skilfully managed, even by the most adequate" of Social Workers, cannot be expected, when it comes from a source which the home regards as official and which is only called in for the occasion, to be received with quite the same confidence and, in a sense, the same affection as it would be if it came from the family physician. Confidence and a of affection are necessary prodromal states for the successful degree education of anybody in anything worth while. Social conditions being what they are, and with the spread of industrialism and an atmosphere of mass-produced specialisation in semi-state medicine slowly turning the flower of our modern civilisation into a uniformly dull, impersonal?but admittedly efficient?signpost, we are getting further from instead of closer to a condition in which the ancient relationship of physician to patient forms a solid and necessary background to the technical practice of psychological medicine. Character defect is one of the by-products of a too-rapidly socialising machine. It is a mistake to make life too easy too quickly; and it is a striking fact that the form of character defect of which I speak is seldom if ever seen in those who, through circumstantial adversity, have achieved a proper and balanced sense of humility; they get their values right. The socialising machine, however, is going on; and no one could stop it even if they wanted to; so perhaps, after all, the negativistic brigade are right?quite unwittingly?and it is better just to go on doing nothing about it; but it is an aspect of psychology (and, I suppose, of that rather neo-inscience, Sociology) upon which mature reflection cannot tellectual-sounding but enrich our studies,