11. Criminology and the Sick Society

11 Criminologyand the Sick Society JAMES W. WIGGINS Psychoanalysis is more than a system of therapy ... it is a scientific discipline dealing with the psychological dynamic forces within the human being, whatever the manifestations of the forces may be: mental disease, artistic endeavor, religious thought, literary expression, or social psychology and behavior.! The persistent and increasing efforts of mental health pro fessionals and their ancillaries to move out into the community at large, prescribing generally procedures yet unproven even in personality disaster, has been noted by a number of observers. 2 If a tangible product were advertised with such enthusiastic claims, it might lead to an investigation by the Federal Trade Commission and an order to cease and desist. The invasion of major institutions and value systems by psychiatric and quasi psychiatric theories-often in untested or untestable forms apparently springs from an optimism not sobered by a sense of great responsibility. This invasion is not a passive entry into a vacuum, but rather an active attempt at displacement of elements both in society and the human personality. Would it not be logical for public and governmental concern about the unadver tised side effects qf drugs and about the unproved claims of their manufacturers to extend itself to the kind of "medicine" dis pensed by the psychoanalyst?

The present analysis is focused on the intensive and.continuing 211 212 Psychiatry and Responsibility efforts to substitute the psychiatrist and his cohorts for present systems of crime control. While these efforts are more than a century old, they seem to be gaining ground increasingly. It is not argued here that the more or less established and traditional methods of crime control have attained perfection or contributed to the ideal society. The main argument of this paper is that psychoanalytical psychiatry has yet to prove-scientifically and pragrnaticaJly~that its invasion of the process of crime control will result in greater benefits to society and those of its members who are not engaged in criminal behavior than the former methods. The appearance in 1960 of The Psychology of Crime)3 by David Abrahamsen, M.D., merely reinforces an approach to crime also suggested, e.g., in Franz Alexander and Hugo Staub's The Crim inal) The Judge) and the Public. 4 It is probably fair to select these spokesmen for the group which currently seems most energetic in the area. McCorkle states that the school of psychiatric thinking most directly identified with this effort has been the psycho analytic school, represented by such writers as Abrahamsen, Zil boorg, Alexander, and Lindner, among others. 5 A few quotations will present the position: It is through m.edicine that psychoanalysis was born as scientific dis cipline, and the greatest majority of scientific analysts still consist of medical men. The pal'ticular field of criminology could not be studied in sufficient depth without medical men .... 6 It is no longer necessary to try to justify the claims psychoanalysis makes in understanding the mentally sick and in extending to them therapeutic help.7 We thus try to justify our interest in the criminal by means of an assertion~ the COl'rectnessof which is ... not yet proved. 8 The combination of medic:al and psychoanalytical attitudes is the most favorable for a tolerant and unemotional study of human. behavi(j:r~ especially. social behavior. 9 Criminology and the Sick Society 213 The main question whether or not a given act is to be considered criminal depends entirely upon the psychological diagnosis we make.lO Alexander reserves· to the psychiatrist the right to decide whether a crime has been committed; Abrahamsen suggests that the person who commits the act may not be the criminal even if a criminal act is committed. In his treatment of rape, Abrahamsen suggests that the married rapist has been "seduced" by his wife into committing the crime, and she is thus the real "criminaL"

The unmarried rapist may be understood as engaged in a dis placed attempt to force his seductive but rejecting mother into submission. l1 Abrahamsen also declares that only the psychiatrist can determine when an offender should be released. 12 The point has been made that contemporary psychoanalysis seeks to enter the law enforcement system at least to the extent of determining whether the accused is guilty or not and deter ... mining what----if any'"---"actionis to be taken toward the guilty and by whom the action is to be taken. This is considered essential, not only for the reasons indicated in the quotations above, but also because the psychoanalyst alone can make judgments which H may be just beyond question." This is taken to be a social value because, the position con tinues, "any disturbance of the common sense of justice has a destructive effect on society." "When the Sense of justice is dis turbed, then that part of our Ego which Was called by Freud the Superego and which is yet in a rather weak state of organization, loses its power over the asocial impulses of the average indi vidua1." 13 The· "average individual," then, cannot be trusted to recognize justice, but is rather asked to turn it over to psycho...

analysts, who can administer justice with uncommon sense. It is perhaps unfortunate that the writer's Contacts with pris.. oners have led to the conclusion that the convicted have a sense of justice which is reassured by equal punishment for equal violations. I have found no enthusiasm for sentencing pro cedures that allocate penalties erratically. The analyst might well treat one imprisoned petty thief for life, and another for a week. Since these psychoanalytical infiltrations of traditional systems 214 Psychiatry and Responsibility of crime control prosper in considerable degree because of the invocation of "science," as contrasted with the "unscientific" at torneys, courts, juries, and prison officials, the "science" itself deserves careful scrutiny. A standard basis of scientific procedure is the requirement that concepts be rigorously discriminating and exclusive. The transformation of concepts during the course of scientific investigation vitiates and makes incomprehensible the results of the study. In this regard, Robert M. MacIver offers four caveats.14 The first caveat warns (sic) that a social phenomenon defined by law or other institutional procedure cannot be referred to a set of causes lying outside the institutional system itself. Since crime is defined by law, a considerable share of the fluctuations in crime rates is produced by variations in the law itself.

Donald R. Taft points out, as do other criminologists, that legal definitions of crime have expanded tremendously in the past generation. 15 With no changes in behavior, no changes in per sonality, there has been a marked increase in "exposure" to definitions of actions as criminal. The adoption of the Sixteenth Amendment to the United States Constitution produced a whole new range of possible crimes, quite independently of personality. The adoption and later repeal of the Eighteenth Amendment first extended, .then contracted the list of activities defined as criminal. The Prohibition Amendment made Al C'!pone's career possible, while it took the Income Tax Amendment to make his imprison ment possible. The burgeoning of administrative law and its bureaucratic creation (and administration) have produced new points of referente and new settings for the determination of crime. MacIver's second warning is most direct for psychiatry and criminology. "We should beware of identifying, for purposes of causal derivation, the phenomena we are seeking to explain with any category narrower or broader than that constituted by the phenomena themselves." Even admitting for the moment the validity of the categories of lawful behavior and mental health, there is an implicit violation of the caveat in the customary interCriminology and the Sick Society 215 change of these categories. To find occasionally the same person with both sets of relevant properties by no means protects the confuser.

The category "crime" is clearly and by definition relative to the law, while the category of mental illness varies independently of the law. The behavioral patterns taken to reflect mental illness at best would depend on consensus among psychiatrists-but even this is presently unlikely. The frequent use of "boards" or "com missions" of psychiatrists in the determination of mental illness and the disagreements among the professionals themselves indi cate considerable uncertainty. If the decision is to be made by vote, it is difficult to understand why anyone set of voters has a particular claim to the power of decision. While MacIver's third caveat is more general in its application, the fourth again refers to psychiatric or quasi-psychiatric theories of crime. "We should not assume that when a number of condi tions are together operative in the production or emergence of any phenomenon each of these conditions can be assigned a specific weight, influence, or percentage of contribution toward the resultant phenomenon." One might almost believe that the fourth caveat was designed specifically with Sheldon Glueck in mind. But the Gluecks are not the only criminologists who tend to allocate weights (hopefully totaling one hundred per cent) to various causative factors found associated with certain types of crime (and particularly youthful crime) in certain types of people in certain circumstances. "Dynamic" psychiatry would hardly make this error, since Glueck's theories and predictive tables tend to exclude the modification of probabilities arising from the "interaction" of the contributors to human action, legal or illegal.

The violation of the fourth caveat leads to segmental handling of personal and environmental components so that the inter .. relationships may not appear. It is unfortunate that the situation is even more confused than has been suggested so far. The assumption that the goal of the psychiatric enterprise can be a stable referent-mental health is doubtful. The content or the properties of mental health must 216 Psychiatry and Responsibility be communicable if it is to be a subject of meaningful discussion. The content is elusive, not to say illusory. Marie Jahoda states: Perhaps the greatest handicap for the systematic study of the social conditons conducive to mental health is the very elusiveness of this concept. As far as we could discover, there exists no psychologically meaningful and, from the point of view of-research, operational de scription of what is commonly considered to constitute mental health. 16 After extensive analysis of the question, Joseph Eaton concluded: A frank recognition of the relativity of mental health will do much to improve research and its application .... It is a value judgment, with all the potentialities for variation and change implicit in such a rela tivistic entity ... Mental Health as a scientific concept does not now exist.l7 More recently, HarryC. Solomon, M. D., introduced a sym posium volume, Rehabilitation of the Mentally Ill) by stating that "The phrase rehabilitation of the mentally ill, although widely used, is not readily defined." 18 The rather heavy volume, Mental Health and Mental Disorder) edited by Arnold Rose, does not include an analysis of either of the concepts-possibly on the brave assumption that all of the contributors were writing about the same things. 19 It is unnecessary to document further the am bigui ty in the referent.

Despite the conceptual confusion, it is appropriate to examine the practical consequences of the application of the procedures offered society and its law enforcement agencies. In the first place, the psychiatric enterprise may be viewed as a social institution. In the second place, it may be examined as a set of procedures in tended to modify behavior and applied to individuals (or groups). From the institutional point of view, evaluation procedures may determine the degree to which societal or community alarm in the presence of bizarre and unpredictable behavior is reduced or eliminated. There may be considerable reassurance for society Criminology and the Sick Society 217 in having someone do something, preferably ritualistic, when the society is faced with an incomprehensible disaster. Anthropologists have described such ritualistic procedures in scores of nonliterate societies. Burial rituals, which reassure the living that death can be assimilated by the community, are perhaps universal. It seems to follow, however, that burial rites for the living as well as the dead will tend to reduce the efficiency of the ritual. From the standpoint of reassurance to the society or the community, it might be suggested that psychiatry is effective to the degree that the society ignores, or faces without alarm, ·its few members who cannOt acquire, or who are cut off from, the commonalities of the society.

This particular function of psychiatry may be most effectively performed if the cost of the performance is high. There seems to be a rather direct relationship between the restoration of equanimity and the cost of its restoration. There are psychiatric grounds for this statement, as well as more time-honored religious grounds--since the concept of expiation antedates the origins of modern psychiatry. Even in our "advanced" United States the more costly funeral seems most reassuring, and at various levels of our own society the ostentatious economic wastage of flowers and gleaming, single-purpose Cadillacs may be commonly ob served. It should be noted that from the societal standpoint it is not required that the dead be restored to life as a consequence of this costly ritual; it may be the very fact that restoration is not expected or guaranteed which makes the ritual necessary and worth the economic resources devoted to it. The fact that eventual revival may be assured as a part of the ritual appears not to be an invariable requirement for its efficiency.

In respect to this primary function, mental health specialists cannot get high marks through agitation which produces alarm in society over the handling of its seriously disturbed members. There is no "peace" to be derived from public statements that the ritual being used is not effective, particularly if they are made by the ritualists themselves. It seems rather obvious; also, that threatening statements of inadequacy unavoidably raise ques tions about the qualifications of the "anointed·' ritualists. In 218 Psychiatry and Responsibility any case, the techniques for evaluation of the efficiency of psy chiatryas-ritual are widely used under the label of market re search, and this ritualistic function may be effectively performed without any knowledge of either personality formation or reform ation in patients. If nothing were promised beyond reassurance to society, further analysis would be redundant.

Many outspoken mental health professionals claim considera ble efficiency in the modification of behavior, whether criminal or otherwise undesirable. 20 Acting in the name of science, they can not defer recovery to the hereafter and must be exposed to evaluation in this life. It is the measurement of the results of psychotherapeutic procedures in this life that presents nearly insuperable difficulties. The pretensions to therapeutic success are easily documented. Dr. Harry R. Brickman in 1960 assumed the direction of a $1,000,000 per year public mental health program to assist Los Angeles County's more than 500,000 potentially disturbed indi viduals before they become disturbed. The task will be under taken with the aid of three administrative assistants and ten private psychiatrists, who will serve as part-time consultants. Dr. Brickman was quoted as saying that he will "emphasize a broad preventive approach, since the problems of mental illness must be met before psychoses and severe character disturbances develop." 21 Dr. William Rottersman, citing the case of a young woman "on the verge of suicide," said that there are "probably more pre ventable suicides each year in metropolitan Atlanta (Georgia) than there are deaths caused by polio, tuberculosis, and a number of other publicized illnesses put together." He professed to be able to prevent one hundred suicides per year-if eighteen more public psychiatric hospital beds were made available!22 It is a matter of record, however, that there were fifty-nine suicides in the county which includes Atlanta, and fifty-five deaths from tuberculosis alone in the year 1959.23 It is not clear which "other"

illnesses are to be compared, but it would seem difficult to prevent more suicides than occur, even if the causes of suicide were certainly known.

Criminology and the Sick Society 219 A simple model of measurement of change requires an input with accurately described relevant characteristics, a process, and an output with accurately described characteristics. The before and-after comparison is the index to change. Several special difficulties interfere with the use of this simple model in psy chiatry. The conceptual probl~m.. treated above .. makes it ex tremely difficult to decide which properties of input and output should be described, and this underlies the broader question of description itself. One psychiatrist described to the writer a patient who was thoroughly disliked by his fellow workers until, under therapy, the patient became psychotic. The psychotic patient became a favorite of the same people who had previously loathed him, but was ineffective in other areas. It was difficult, at the least, to say whether the patient was better or worse although from the point of view of his psychiatrist he was worse because his intrapersonal organization had deteriorated. 24 Additional difficulty in evaluation arises from the tendency of guidance clinics and quasi-psychiatric counseling centers to accept only the "easy" cases. Such procedures, in settings which could furnish relatively large numbers of evaluative situations, unavoid ably bias the observations in favor of success. There may well be some "patients" adm~tted who are suffering, for example, real neurosis, and whose recovery is produced by the removal of a real environmental threat over which the therapist had no control.

It is difficult indeed, as physicians have often reported, to determine which "successes" are basically spontaneous recoveries and which are the result of therapy. The problem of remissions in psychotherapy may present much greater difficulty. A special obstacle to the evaluation of psychiatric work is a consequence of the limited training in research methods included in the medical school curriculum. This gap in training leaves no alternative to generalizations based on clinical observations, in which the clinician is properly involved personally. W. Horsley Gantt, M. D., of Johns Hopkins University, writes: "Unfortu nately, in the U. S. A. it is possible to go through a psych@tric residency without performing a single piece of research or an experiment . . . often no one except the student who makes the 220 Psychiatryand Responsibility formulation can recognize the patient by his description." Gantt continues: "A recognition of what is scientific investigation and what is therapeutic obligation would remove much confusion from our field." 25 Dr. Melitta Schmideberg concurs: Psychiatry has allowed itself to be built up without checking extrava gant therapeutic and scientific claims, as would be a matter of course in other specialties .... Much psychiatric literature is repetitive and unproved while important areas are neglected.

So many psychiatrists naively assume that their observations are neces sarily valid, encouraged by Freud's ambitious notion that the psycho analyst becomes an objective instrument of science merely by removing his emotional bias by being analyzed. His was a revolutionary concept. Unfortunately, however, it proved wrong. By now, most analysts agree, as did Freud at the conclusion of his life, that training analysis fails to achieve its objectives; indeed, Glover thinks the longer the analysis, the greater the element of suggestion. But the conclusion that the analyst is not entitled to scientific license merely by virtue of having been analyzed, has not yet been drawn. 26 It cannot, of course, be said that all psychologists and sociol ogists produce research that is beyond criticism. It is probable, however, that the professional sociologist or psychologist is likely to be somewhat more sophisticated in research techniques than the psychiatrist. The assumption of the role of evaluator in the field of psychiatry, however, by either psychologist or sociologist produces a social structural strain. This may be especially true of the psychologist. The division of labor between psychiatry and psychology has not yet reached the point of mutual agreement.

Each profession feels that it has areas of superior competence, but the areas claimed overlap. The sociologist, on the other hand, does not usually compete for therapeutic responsibility, and may more easily "accept" a division of labor that allows him to measure change. In view of the general and special problems outlined above, it Criminology and the Sick Society 221 is not surprising that rigorous systematic measurements have been few. Carl Rogers introduced in 1954 his Psychotherapy and Personality Change with the statement: "It isn't good research in psychotherapy; it's just the best there is." This statement is so significant because it was the first full-scale effort to measure the results of two types of psychotherapy. Rogers reported, with qualifications, some change in hypothesized directions in a sub~ stantial proportion of the experimental group that remained to be evaluated until the end of the study. His study was based on thirty cases.27 An extensive survey of evaluative studies in mental health, published in 1955, was prefaced by R. H. Felix, M. D., director of the National Institute of Mental Health. 28 The survey identi fied 984 articles and books that seemed directly or tangentially related to evaluation. A concluding statement by the Working Committee that produced the study reads, not hopefully, as follows: In the process of reviewing various studies reported in the literature the Committee has been impressed with the .number of studies which neither fulfill the role of exploring new leads nor serve to adequately validate earlier established leads.29 Since the Rogers study found it necessary to discard the con cept of "success" as a therapeutic outcome, it may be worthwhile to report briefly on the new survey volume, Americans View Their M ental Health. In this nationwide survey, respondents who had sought help in the solution of their problems were asked to state the amount of "help" they had received from the specific sources they used. The percentages of those using specific sources who said they had been helped" (unconditionally) or "helped a lot"

were as follows: Clergy 65% Doctor 65% Psychiatrist 46% Lawyer 62% (N-130) (N-89) (N-46) (N-13) Again, the authors report that when respondents were asked how they were helped, "most of our respondents could not describe 222 Psychiatry and Respons.ibility explicitly how therapy had helped them, [but] they gave responses generally relevant to this question." so (Italics added.) Liza P. Holt makes the following comment about evaluation: In view of the quite considerable disproportion which does currently exist between enthusiasm for propagating mental health on the one hand, and scientifically verified conclusions about the effects of various means taken toward this end on the other hand, I rather imagine that many workers in the field would be satisfied with what seems a far simpler and less demanding form of evaluation. The criterion of suc cess which might seem sufficient to such people can be called the criterion of subjective conviction .... Something can be said in favor of this criterion, scientifically indefensible though it may seem... )H This is an interesting evaluation of patient change through examination of feeling tones of the therapist. It may well be "scientifically indefensible," but, as George VoId has shown, it is hard to go any further .

. . . A methodology under which only the patient knows the Ufacts" of the case, and only the analyst understands the meaning of these Ufacts" as revealed to him by the patient, does not lend itself to external, third person, impersonal verification, or to generalization beyond the limits of any particular case.32 Having examined some of the claims, the concepts, and evalu ative efforts in the area of psychoanalysis and psychotherapy, we may appropriately consider directly how these ideas interfere with control of crime. While the layman has recognized for centuries that some humans are so different that they cannot be held responsible, and while mistakes have no doubt been made, he has for millennia managed to keep crime under reasonable control in most circumstances. This layman, in his many roles and manifestations, has been able to maintain sufficient order in society to give most citizens overextended periods of time free dom of serious threat to life, property, and person. Even despite a c'ontinuing increase in the areas of life restricted by state action, constituting ever more opportunities to break a law, there Criminology and the Sick Society 223 is some evidence that' crime rates have declined in the United States, at least.

Laymen could be given some responsibility for the sensible modifications of the French Code of 1810, which allowed exemp tion from criminal· responsibility for certain classes of the insane and for children. The classical reference for the British and American concepts of legal insanity is the M'Naghten Rule (1843). This test for criminal irresponsibility required that it be "clearly proved that at the time of the act the accused was laboring under such a defect of reasoning as not to know the nature and quality of his act, or, if he did, that he did not know that what he was doing was wrong." 33 The Rule has been under attack increas ingly, because it does not excuse enough criminals of their responsibility for violation of law. It should be noted that not all psychiatrists have attacked the M'Naghten Rule. Nevertheless, Abrahamsen does complain that a supporter of the M'Naghten Rule, psychiatrist Percival Bailey, "does not seem to have special ized experience in the field .of criminal psychopathology." 34 Obviously, then, Bailey cannot know what he is talking about!

Abrahamsen complains also because Jerome Hall, a legal scholar who has cogently supported the M'Naghten Rule, "does not cite opinions of psychiatrists who constantly deal with these specific problems." 35 Hall might have quoted Melitta Schmideberg, Chairman, Executive Committee, Association for Psychiatric Treatment of Offenders. Reporting on a conference on the psy chiatric treatment of juveniles, Schmideberg wrote: "The chief impression shared by the participants was how little we know on this important subject .... In trying to arrange the conference, I was impressed that several well-known psychiatrists refused to speak because, although they had examined or treated juvenile murderers, they had learned so little that they did not feel jus tified in speaking." 36 An enthusiastic professional group rewarded Judge David Bazelon for contriving the Durham Decision of the Court of Appeals of the District of Columbia. This decision extended crim inal irresponsibility tremendously, and Judge Bazelon was granted the Isaac Ray Award for his service to psychiatry. The distin224 Psychiatryand Responsibility guished Mr. Justice Douglas of the United States Supreme Court called the opinion "imaginative," no doubt intending a compli ment. 37 A brief examination of the decision certainly confirms its imaginative quality.

Judge Bazelon decided: "An accused is not criminally respon sible if his unlawful act was the product of mental disease or mental defect." 38 Brickman stated (above) that a half million people in Los Angeles, in addition to those who were really dis turbed, had the seeds of disturbance already in them. Abraham sen cites the studies of the Gluecks, and of Drs. Healy and Bron ner, showing respectively that 51.4% and 91 % of delinquents had deep emotional disturbances. 39 The latter figure means, under the Durham Rule, that 91 % of delinquents cannot be held respon sible for their criminal actions. A third exercise in irresponsibility is found in the plea of "irresistible impulse." The offender with a "character disorder" just cannot control himself when he feels the impulse to commit crime. Only persons who have committed crimes can report an irresistible impulse. It is obvious that any criminal act, by its very commission, was not controlled} and hence was a response to "irresistible impulse."

It is not surprising, in view of the foregoing, that Dr. Manfred S. Guttmacher quotes with approval the following satirically re signed statement by Lady Wootton: ... The only solution, as I see it, is to give up trying to draw the line between the responsible and the irresponsible, and to recognize that once we have departed from the comparative security of the M'N aghten formula there is no logical resting place short of abandon .. ing the questions of responsibility altogether .... In that case every.. thing except treatment--guilt, responsibility, and all the rest of it would become irrelevant. 4o It is now appropriate to give some attention to the theory of treatment. The examination of the outcomes of treatment (above) is not encouraging. Theories of treatment may nevertheless promCriminology and the Sick Society 225 ise modification of criminal behavior. Two general basic objec tives are apparently sought in the psychoanalytic therapies. The first objective may be characterized as the reduction of the power of the Superego. The second, and currently popular, goal is to increase Ego strength. 41 In the effort to control criminal behavior, certain consequences fo1101'v the destruction of the Superego. There are many defini tions of the Superego, but they seem to vary around the central idea of an internalized system of external authority. This is the part of the personality which contains social norms, including legal norms, and which "punishes" the violator of norms. If this reading of Freud and neo-Freudians is approximately correct, the conclusion becomes obvious. The reduction of the force of the Superego reduces internal controls and frees the personality of inhibitions to exactly the degree that therapy (with this object) is successful. The rapist who is encouraged to feel "good" about his crime is in effect told to "go and sin some more." The psycho..

pathic personality is devoid of Superego, incapable of remorse. Where else does the reduction of Superego lead but to the psycho.. pathic personality? The support of the Ego may be viewed as complementary to Superego reduction. If, as Abrahamsen states, the juvenile delin .. quent is "generally speaking .... much more demanding than the nondelinquent," 42 it is difficult to comprehend a theoretical reduction in "demanding" behavior through adding strength to the Ego which "does" the demanding. The Ego can hardly gain strength at the expense of the Id, since instincts cannot be modi fied. It must therefore grow at the expense of the Superego and further reduce the power of conscience to "punish" unlawful be.. havior. So both objectives, even if achieved, reduce controls on the behavior of the violator. 4s The further encouragement of irresponsibility comes clear through a sociological analysis. The criminal is classified as "sick"

if he shows any of the "symptoms" that satisfy the psychiatrist, and it is even urged that the terms "mental disease or defect" jn~h.ldc "!J.l>n9rm!J.litie~" manj£e~ted only by repeated criminal or 226 Psychiatry and Responsibility otherwise antisocial conduct. If symptoms cannot otherwise be identified, the crime itself serves-as with the irresistible impulse (above).44 Statuses in societies universally involve reciprocal rights and duties, and one person's rights may be another's duties. The infant, the senile, and the insane in American society are given additional rights and are excused from many duties. It is also true that the person with physical illness, with observable symp toms, is given additional rights-to be cared for, to have special foods, special coddling, to be served food in bed-and is excused from normal duties-going to work or completing household chores or paying bills. The sick have a special status, very closely resembling that of the infant. The status is "approved" by general consent.

Even the temporary movement of an adult into the status, "sick," interrupts the ongoing social relationships. The sick father cannot function as father: and, in effect, there is no father. Some one else must assume father's duties. This change can, of course, be generalized to any other status. If all violators of social norms, including legal norms, are to be added to the "sick," the criminal and other violators not only have the assurance of therapists that they have no responsibility, but also have the warm blanket of approval of their irresponsi bility from the bulk of society. The ultimate in the support of irresponsibility, going far be yond destruction of the Superego, the aggrandisement of the Ego, or the release from duties for sickness, is the concept of the sick society. Following the precedent of Freud, Horney seems to think that patients [read "criminals"] are always looking for some one to blame for their difficulties. Sullivan and Fromm believe that blaming others has its place. 45 Clara Thompson is not alone when she states flatly, "We live in a sick society with which we must make some compromise." 46 The idea of the sick society, positing various types of sickness, has been expressed many times. K.arl Marx noted and attacked the sick society. Enrico Ferri, W. A. Bonger, and many others who have identified uncontrolled determinants of criminal beCriminology and the Sick Society 227 havior have taken similar positions. There is an implicit con tempt for the human personality, for man himself, in statements which describe him as a leaf on a turbulent ocean. Certainly if society is sick, man cannot be expected to accept its erratic, nor mative frustrations, and the whole notion of violative behavior is irrelevant to human action.

The final outcome of such explanations as that of the sick society and the irresponsible criminal is described by George VoId: [This one history] highlights ... the ease with which [this theory] fits into totalitarian patterns of government. It is centered on the core idea of the superior knowledge and wisdom of the scientific expert, who, on the basis of his studies, decides what kind of human beings his fellow men are who commit crime, and who, on the basis of this knowledge and scientific insight, prescribes appropriate treatment without concern for public opinion and without consent from the person so diagnosed. 47 The power struggle will continue. This brief analysis of the claims to power of one set of antagonists has referred to garbled concepts, inadequate or negative evaluations of results, and theo retical weaknesses underlying the anticipated results. The case for the substitution of psychiatric and quasi-psychiatric procedur~s for the relatively effective if equally unscientific, democratic sys tems of crime control is far from adequate. For the protection of the criminal from his own excesses, for the protection of the genuinely ill, and even for the protection of the relatively well if such there be-better results must be shown before jails can be emptied or even converted to open-ward hospitals.48 NOTES 1. Franz Alexander, M.D., and Hugo Staub, The Criminal" The Judge" and The Public (Glencoe, Illinois: The Free Press, 1956), p. vi. The quota tion is from Gregory Zilboorg, the translator of the work, which was originally published in Germany. The first American edition appeared in 1931.· 2. For extended documentation see Michael Hakeem, "A. Critique of the 228 Psychiatry and Responsibility Psychiatric Approach to Crime and Correction," Law and Contemporary Problems, Vol. XXIII, No. 4 (Autumn, 1958), pp. 650-682. Also see A. H. Chapman, M.D., "Psychiatrogenic Illness," The American Journal of Psychiatry) Vol. CXVI, No. 10 (April, 1960), p. 873.

3. New York: Columbia University Press, 1960. 4. Alexander, op. cit. 5. Richard R. Korn and Lloyd W. McCorkle, Criminology and Penology (New York: Henry Holt and Company, Inc., 1959), p. 442. 6. Zilboorg, in Alexander and Staub, Ope cit.} pp. vii..viii. 7. Alexander, Ope cit.} p. xvii. 8. Ope cit.} p. xix. 9. Zilboorg, in Alexander, op. cit.} p. viii. 10. Alexander, Ope cit.} p. xviii. 11. David Abrahamsen, M.D., The Psychology of Crime (New York: Columbia University Press, 1960), p. 165. 12. Abrahamsen, Ope cit.} pp.. 276 £. 13. Alexander, Ope cit.} p. xix 14. Social Causation (New York: Ginn and Company, 1942), pp. 77-95. 15. Criminology (3rd ed.; New York: The Macmillan Company, 1956), pp. 387·90. 16. Quoted in U. S. Department of Health, Education, and Welfare, Public Health Service, Evaluation in Mental Health (Washington, 1955), p. 6. 17. Ope cit. p. 9. 18. Publication No. 58 of the American Association for the Advancement of Science (Washington, 1959), pp. iii, iv.

19. New York: W. W. Norton & Company, 1955. 20. See Hakeem for elaboration, Ope cit. 21. New York Times) April 10, 1960. 22. Atlanta Journal} February 11, 1961. 23. Georgia State Department of Public Health, Vital Statistics} 1959, p. 46. 24. See} in this connection, A. H. Chapman, Ope cit. 25. "Objectivity in Psychiatry," The American Journal of Psychiatry} Vol. CXIV, No. 12 (June, 1958), p. 1046. 26. "Psychiatry and its Methods," The American Journal of Psychiatry, Vol. CXVII, No.7 (January, 1961), p. 664. 27. Chicago: University of Chicago Press, 1954, p. 5. 28. See note 15. 29. Ope cit.} p. 28. 30. Gerald Gurin, Joseph Veroff, and Sheila Ford, Americans View Their Mental Health (New York: Basic Books, Inc., 1960), p. 319. 31. Quoted in Evaluation in Mental Health} p. 19. 32. Theoretical Criminology (New York: Oxford University Press, 1958), p.125. 33. Abrahamsen, Ope cit.} p. 247. 34. Ope cit., p. 249.

35. Ibid. 36. "Murder by Adolescents," (Correspondence), The American ]o,#rnaj pI P~ychiatr:y, Vol.. eX-IV! No.. 12 (June, 1958), p. 1045: Criminology and the Sick Society 229 37. Manfred S. Guttmacher, M.D., "Current Trends in Regard to Criminal Responsibility," The American Journal of Psychiatry~ Vol. CXVII, No.8 (February, 1961), p. 684. 38. Abrahamsen, Ope cit.~ p. 250. 39. Ope cit., pp. 82-83. 40. Guttmacher, Ope cit.~ p. 691. The reader is urged, however, to acquaint himself with the full interpretation Barbara Wootton has devoted to the subject in chapter VIII, "Mental Disorder and the Problem of Moral and Criminal Responsibility," in her Social Science and Social Pathology (London: George Allen & Unwin, 1959). 41. For various approaches to the problem, see Clara Thompson, Psycho analysis: Evolution and Development (New York: Hermitage House, 1950). Also see O. Hobart Mowrer, The Crisis in Psychiatry and Re ligion (Princeton: D. Van Nostrand Co., Inc., 1961), especially chaps.

2 and 13. 42. Abrahamsen, Ope cit.~ p. 68. 43. Ope cit., p. 72. 44. Guttmacher, Ope cit., p. 690. 45. Thompson, Ope cit., p. 202. 46. Ope cit., p. 242. 47. VoId, Ope cit., p. 35. 48. For a more extended analysis and a broader coverage, see Arnold W. Green, Crime and Its Defenders (New York: McGraw-Hill Book Com pany, Inc., 1962).