Impulsive Disorder

IMPULSIVE DISORDER, a name sometimes given to certain conditions developing in psychopathic individuals, on the basis of which they from time to time commit unexpected actions, most often contrary to the norms of law or the rules of social conduct (see Impulsive actions). These actions have as their basis an irresistible urge to satisfy one or another pathological inclination and thus represent a manifestation of blind and unreasoning force of drives, rather than will based on discussion of motives. As Kraepelin says, the patient simply feels compelled to perform a certain action: something comes over him, forcing him to act at all costs, even against his own convictions. Therefore, the corresponding action acquires the character of immediacy, lack of forethought, purposelessness, and even meaninglessness. However, in contrast on the one hand to impulsive actions of schizophrenics, and on the other to various kinds of compulsive acts and anxieties, such a patient's actions do not seem unnatural or incomprehensible to him; on the contrary, they express his hidden desires. In what he does, there is something tempting and alluring for him, although often rejected by his conscious will. Following his impulses, the patient usually experiences an immediate feeling of deep satisfaction. Obstacles only strengthen his urge, while failures distress him. Sometimes before committing reprehensible or dangerous acts, an inner struggle with moral prohibitions and arguments of reason begins in the patient, but often even the most abominable acts are carried out with calm assurance and without any hesitation. The best-known types of I. d. are as follows. 1. Impulsive arson (pyromania). In these cases, the matter usually concerns infantile, physically and mentally underdeveloped inadequate individuals, most often adolescent girls, sometimes also at the time of the crime menstruating. In its simplest form, the urge to set fires in them stems from the love for the sight of fire spreading and burning, which is inherent in normal people, especially children and adolescents. In pathological cases, the pleasure derived from this sight proves to be so strong that the desire to see it grows to the degree of an irresistible passion. If the case concerns an immature personality with insufficient intellect or poorly developed inhibitions, then all the conditions are present for this passion to pass into the corresponding action under favorable conditions. With repetition, the influence of habit and the interest aroused by the sight of alarm and commotion is added, as well as the feeling of hidden pleasure from the consciousness of one's power. In more mature years, the passion for arson most often weakens and disappears. 2. A more complex group is formed by cases in which arson represents a manifestation of destructive tendencies, an impulsive explosion discharging excessive affective tension. Classic examples are the crimes (arson + child murder) of primitive peasant adolescent girls described by Jaspers and Kretschmer, who for the first time entered service as nannies and found themselves in an alien environment. Unusual working conditions, loneliness and homesickness created in these cases a passionate need at all costs to escape from the unbearable situation, as a result of which the thought that involuntarily arose in consciousness about destroying the foreign children and foreign house of the future criminal became especially alluring and attractive. The crime itself was committed almost as an automatic act, barely reaching consciousness (Kretschmer speaks of a physiological analogy with the mechanism of a short circuit of electric current). Of course, the combination of child murder with arson is by no means necessary: often the case was limited to child murder alone. Cases of all other aggressive and destructive acts have also been described, based on the same mechanism of the immediate—without discussion and evaluation—transition of an affectively colored representation that has seized consciousness into an impulsive action. 3. Kraepelin also includes in one group with the above-mentioned cases the cases of completely conscious, cold-blooded and well-thought-out multiple secret murders of children by persons whose care they are entrusted to. In essence, however, these are crimes of quite a different kind, standing much closer to the cases of secret poisonings described below, together with which they already somewhat go beyond the limits of I. d. in the narrow sense as defined above. The cruelty and unnecessary nature of these crimes inevitably arouses the thought of their sexual (sadistic) basis. 4. Poisoners. Secretly adding poison is the tool of the weak, and in it one can often notice the action of Adler's mechanism of overcompensation (see Adler's teaching). The allure of this deed is that here one can achieve stunning results unnoticed, remaining oneself in the shadows, literally gaining power over the life and death of close people. Poison is added by poisoners to their victims during a friendly shared meal, sprinkled into sweets for playing children, etc. The most striking example of people of this type was Anna Margaretha Zwanziger, who lived in the early 19th century—a vain and craving for attention ugly woman with an ugly face; deep dissatisfaction with her fate and envy of other people intensified to an extreme degree her inherent cruelty, malice and contempt for people. Under the mask of humbled humility and obsequiousness, she ingratiated herself into the households of rich and noble people, each time hoping to realize her dream of a brilliant marriage. She eliminated men who did not succumb to her charms, their fiancées, and finally everyone who interfered with her, with the help of poison, sometimes deliberately giving it in small doses to cause slow chronic poisoning. 5. Impulsive theft (kleptomania) encompasses diverse forms, the most common of the types of I. d. The simplest cases here, as in arson, are difficult to distinguish from ordinary theft caused by greed and the urge to appropriate. Such are, for example, thefts from shop counters and displays, committed by materially secure persons, mostly women, who cannot find within themselves the strength to resist the temptation to appropriate temptingly displayed items: they are overcome by a feeling of such greed and such a state of passionate excitement that they completely forget their moral principles, not alien to them in general, the possibility of exposure and its probable consequences, and indiscriminately grab and hide everything that comes to hand. Caught, they declare that they themselves cannot explain how this happened to them, that as if some foreign force guided them—words which cannot always be entirely taken at face value. In a number of cases, however, the undoubted pathological nature of the behavior of kleptomaniacs is confirmed not only by the meaninglessness of their thefts, which become an end in themselves (purchased or gifted items do not give as much pleasure as stolen ones), and not only by ineradicable recidivism, but also by deep pathological heredity, as well as by the fact that, for example, women especially easily succumb to temptation during critical periods of sexual life (puberty, menstruation, pregnancy). Often such patients persistently but fruitlessly struggle with their inclinations (one patient of Kraepelin sewed her pockets shut so that there would be nowhere to hide what she had taken) or return stolen things back. However, it often happens that in them, obviously pathological actions alternate with thefts of a clearly fraudulent nature. Sometimes, impulsive theft stands in a definite connection with the simultaneously arising sexual excitement. In some cases, the latter is colored with masochistic traits and is caused by the fear of being caught, sometimes reaching the degree of orgasm precisely at the moment of apprehension, while in others it depends on the fetishistic tendencies of the thief. In thefts of the latter kind, only certain items are stolen: shoes, stockings, garters, handkerchiefs, etc. Many fetishists eventually form entire collections from such stolen items. Usually the tendency to carry off and hide other people's things appears in kleptomaniacs already in childhood, weakening in some in more mature years. In their psychological makeup, some kleptomaniacs, like arsonists, are characterized by general immaturity and intellectual insufficiency, while others exhibit a number of traits connecting them with hysterics and pathological liars. In addition to the forms mentioned above, some cases of writing anonymous letters and denunciations, a passion for unnecessary purchases, as well as impulsive wandering (poriomania), pathological cases of card and other gambling, dipsomania, sexual perversions, etc. are also classified as I. d. (see also Sexual perversions). As for the essence of I. d., in different cases it apparently plays out on different soil (in psychopaths of various groups) and has different mechanisms as its basis. Many modern psychiatrists, proceeding from this consideration, generally refuse to single out this group as a separate disease.

According to Kraepelin, all the described forms are united by the presence of a disharmonious relationship between various sources of behavior—drives and will. The latter represents one of the later products of phylogenetic development of man, is to a large extent supplemented by education, and amounts to the ability to limit the strength of primitive instincts. In many forms of psychopathic underdevelopment, the formation of this higher psych layer is delayed, while the more primitive motor forces of the organism—not only the drive for food and reproduction, but also the striving for self-affirmation with the resulting blind will to power, affects of envy, jealousy, and revenge, combined with the tendency to imitation, receive excessive development. It is important to emphasize another remark of Kraepelin's, that neither pyromania, kleptomania, nor other described pathological manifestations represent some limited diseases that completely change any one limited psych function. 'In reality,' says Kraepelin, 'in all these cases we are dealing with natural drives, only having taken on a pathological form and spread due to the absence of inhibiting and transforming counterforces brought into action by higher psych functions.' Perversion of drives, if it exists, in a considerable number of cases apparently represents a consequence of a pathological habit developed on the basis of gradual accumulation of corresponding conditioned reflexes (psychoanalysts in particular point to the important role of sexual associations fixed for one reason or another in early childhood). It is important to remember with respect to all forms of Impulsive Disorder that the necessary soil on which they alone can arise is one or another psychopathic predisposition. Impulsive Disorder is one of the forms of pathological reactions of constitutional psychopaths. The forensic psychiatric significance of the cases described above is not the same. With respect to them more than to any others, the position applies that the criminal act must be evaluated necessarily in connection with the entire personality of the criminal. Where we are dealing with states that really exclude the possibility of control over the criminal's actions on the part of his consciousness and will, one has to speak of insanity. In most cases this is connected with the necessity of raising the question of measures necessary to protect society from the possible repetition of the crime (compulsory treatment or psychiatric observation in the family). However, with respect to a considerable number of impulsive offenders, one cannot exclude imputability. In particular, judicial practice has shown that the number of thefts committed by kleptomaniics significantly decreases after the court's refusal to recognize them as insane. The so-called 'short circuit' represents a special case of pathological affect.