Psychopathies

PSYCHOPATHIES (from the Greek psyche-soul and pathos-suffering) represent a unique combination of character traits in people who exist at the boundary between mental illness and health. According to Kraepelin, the basis of such a combination is a 'mixing of healthy and disease-like developmental pathways of various kinds and degrees in the personality.' This mixing of different kinds and degrees of developmental pathways, firstly, places the psychopath in a 'borderline' position (under the influence of various harmful factors, he most easily transitions into a state of illness, giving so-called abnormal reactions of varying duration and intensity), secondly, makes his personality structure significantly more confused and complex than we observe when considering the variant of the so-called norm, and thirdly, makes it possible and necessary to separate the psychopath from the mentally ill in the narrow sense in that in the former we observe a mixing of healthy and disease-like (later, pathological) developmental pathways, arising from the essence of his personality development, and not as a result of parasitic coexistence with pathological traits, as in the case of a psychotic (mentally ill person). Kraepelin sees the specificity of the psychopathic personality in two aspects: 1) in the aspect of 'biological' peculiarities of the personality, understanding P. as ununfolded forms of psychoses or as infantile developmental delays, 2) in the aspect of 'social-ethical' evaluations, classifying psychopathic personalities, especially in their main expression, along the lines of 'enemies of society,' 'unstable,' 'swindlers and fantasists,' etc. Characteristically, in this latter aspect, Kraepelin follows the already established tradition in psychiatry of considering the peculiarities of the psychopathic personality from the point of view of its social behavior. [This is expressively stated by the author of the term 'psychopathic personality' Koch (Koch), who considered the psychopath a 'socially worthless personality' (social minderwertig)]. Kraepelin's attempt to overcome this duality in the question of P. was never successful. This tradition in psychiatry of deriving the specificity of P. from the social behavior of the personality should be explained by the special position that this discipline occupied in the entire system of medical knowledge. A discipline that was sometimes based on anatomical-physiological laws, which are the foundation on which the human psyche develops, and sometimes on the laws of the 'spirit,' naturally occupied a special and somewhat ambiguous position in the system of medical knowledge. Of course, this ambiguity in the position of psychiatric research was fundamentally and decisively determined by historical conditions. Already Morel, and then Magnan (Morel, Magnan) in their teaching on degeneration, and in particular on 'higher degeneration' (degeneres superiores), essentially took the path indicated. Before them, Morot-de-Tour, as it were, paved the way for what we find in a more pronounced form in Kraepelin. But it would be a mistake to believe that Kraepelin's teaching on psychopathies is a direct and immediate continuation of Morel's teaching on degeneration. Kraepelin's teaching was a new phase in the teaching on degeneration, which fundamentally changed the static understanding of degeneracy, so brilliantly developed by Morel, Magnan, and others. The novelty of this phase consists in the fact that Kraepelin, despite his ultimate failure in solving this problem, was the first to lay the clinical foundations for the analysis of the psychopathic personality, giving unforgettable images and types of it. It is precisely the clinical basis for considering P. that led Kraepelin to his first aspect - considering them as ununfolded forms of psychoses. Attempts made in this direction at the initial stages of accumulating clinical material reduced to dividing the entire group of P. into torpid (slow) and erethitic (excitable). The obvious insufficiency of such a division, its clinical primitiveness, forces one in the future to go along the path of more detailed differentiation of one type of P. from another. These types of psychopathies are described most subtly and fully by Kraepelin, who, from the point of view of clinical phenomenology, distinguishes excitable, unstable, people of passions, enemies of society, fantasists, swindlers and frauds. This 'nuclear' group of P., as is evident from the mere enumeration of its types, is extremely colorful and is based on the duality in understanding the structure of individual psychopathic types. For example, 'enemies of society,' according to Kraepelin and a number of other authors (this position is also repeated by Gannushkin), represent conflicting people who constantly and unprincipledly fight society by all means, carriers, according to Birnbaum, of a constitutional predisposition to criminal acts. The complex social behavior, determined by the laws of class struggle in capitalist society, thus becomes the result of a peculiar play of biological forces that once and for all determine the fate of a psychopath of one type or another. The perversity of such a typology is self-evident. Further movement of psychiatric thought in this area can be figuratively defined as a peculiar repetition of the path traveled. Thus, the subtle and methodical researcher Kurt Schneider understands by psychopathic personalities 'such abnormal personalities who either suffer from their abnormality themselves or force society to suffer because of their abnormality.' Schneider hastens to add: 'such an understanding is dictated not at all by scientific considerations, but by practical ones.' But in essence, from this demarcation, from attaching the attribute of 'practicality' to such a definition, the latter has lost nothing in its expressiveness: the center of the problem, according to Schneider, is transferred to the plane of social evaluations. Hence it is not surprising that in this problem the naked class interest of the researcher appears with maximum expressiveness. Characteristically, Kraepelin also did not escape this, who in 1918 stated that revolution is made and from which psychopaths and Jews benefit. Following in his footsteps came E. Kahn (E. Kahn), who declared the leaders of the Bavarian Soviet Republic to be 'swindlers, fantasists and fraudsters.' From the other end, but with the same results, in which the class interest is clear and exposed, researchers approach the justification of the historical process. It turns out that the Prussian monarchy in its most vivid expression owes its origin to nothing other than a peculiarly given and hereditarily transmitted interweaving of traits of a known schizothymic triad in the families of Prussian monarchs: pedantry, brutality and viscosity (Kretschmer, Luxenburger). By this, the regularities of the historical process are identified with the regularities of individual development. There is no class determination of phenomena, but there is the fatal development of a personality that appears in the role of the demiurge of history. Motives long known, which received their classic definition given by Karl Marx in the 'Introduction to the Critique of Political Economy': 'The single and isolated hunter and fisherman, with whom Smith and Ricardo begin, belong to the phantasmagoria of the 18th century, devoid of imagination.' This 'phantasmagoria devoid of imagination' reappears on the historical stage in a different guise, with modified goals, but in its essence the same Robinson, freed from all social ties. This 'phantasmagoria' appears in order to affirm the unshakability and stability of the laws governing capitalist society. Such is the meaning of what has been indicated. In this light, characteristic but by no means new, is the latest definition of P., given by E. Kahn in his fundamental work 'Psychopathic Personalities.' He says: 'By psychopathic personalities we understand such discordant personalities who differ in terms of peculiarities of drives, temperament, character (i.e., from the causal side) and who in terms of their life aspirations differ in peculiarities of self-assertion of their value or assertion of the same value by others (i.e., from the teleological side).' This definition in a more subtle and veiled form repeats the previous one and carries within it all its contradictions and vices. In the latter formulation, we have an attempt to connect the characterological peculiarities of the personality with its 'movement,' and the difference between the psychopathic personality and the one within the norm lies, according to Kahn, in the absence of a basic goal, in the substitution of the latter by unstable and transient partial goal-setting, in the undivided dominance of the latter. Despite the fact that the formulations of Schneider and Kahn cited above move us little forward compared to what Kraepelin gave, it should still be emphasized that the path of psychiatric research of P. has shifted from analogizing with psychoses proper to analogizing with characterological data. This naturally gave a reaction in two directions: 1) psychiatrists striving to remain within the framework of purely medical research either try to leave the solution of the fate of psychopaths to 'jurists and educators' (Hildebrandt, Bleuler), or believe that between P. and psychoses there are only quantitative fluctuations (Bleuler, Kretschmer, Berze, partly Gruhle), or believe that work on the problem of P. should be limited to finding certain somato-psychic correlations (M. O. Gurevich, T. A. Geyer), and finally some take the path of finding the genetic radical of psychopathy (Hoffman, T. I.).

Yudin); 2) psychologists claim that the problem of P. cannot be solved without their participation, that it must be entirely shifted onto psychological rails (Klages). In these statements, each side expresses some piece of truth, carefully omitting the multifaceted and complex nature of the entire problem. Finally, in recent Soviet literature, the idea has been expressed that it is possible to understand P. as variants of character, the specificity of which, and consequently their qualitative difference from the so-called norm, lies in a partial (resp. partial) violation of the general sense of "self," understanding "self" not only as the separateness and uniqueness of the subject, but also his connection and community with the collective. This violation is characterized by the dominance in consciousness of the feeling of "self" and is thus a moment of constant irritation of the entire personality, drawing all its interests to this "self." From this side, one can also consider the structure of such a violation, which lies either in the protrusion of the "self," or in its tense concealment, or finally in its alternating swelling and contraction (Vnukov). Pathogenesis and etiology of P. Already from what has been said, the complexity of the problem of pathogenesis and etiology of P. follows. Remaining on the clinical path of research, it should be said that so far no one has been able to reveal the etiology of P. The very variegation of the entire group of P., the diversity of individual pictures of it, makes the task of determining the etiological factor extremely complex. A number of authors (Hildebrandt, Yudin) insist on the outstanding role of the constitutional factor in the manifestation of the psychopathic personality. Moreover, Hoffmann stands on the point of view of the transmission from generation to generation of the main and massive radicals that determine the fate of the psychopathic personality in the order of their antinomicity (opposition-struggle). This point of view is held by the majority of researchers (Dupre, Lange, Minkovskaya, Minkowski, Luxenburger, Kretschmer, Birnbaum, Krasnushkin). Its justification is the undeniable transmission by inheritance of a number of fundamental character traits, either total or partial (Davidenkov, Minkovskaya). We often observe, for example, how an epileptic father passes on to his offspring individual traits of the epileptic character (in one case - stubbornness, in another - explosiveness, in a third - somnambulism, enuresis nocturna, etc.). The question is whether this is inheritance of characterogenic traits or whether it represents inheritance of ready-made psychopathicity. It seems to us that to solve this question requires the maximum accumulation of clinical material, its clear demarcation and differentiation. If we assume that the group of P. should not include everything that in one way or another relates to the so-called organic forms of psychoses (in the form of residual phenomena after encephalitis, after an attack of a schizophrenic process, after various diseases of the central nervous system in childhood), and on the other hand - should not include everything that represents a variant of the so-called norm, even if accompanied by unstable fluctuations at critical age moments, then this group will be defined as characterologically mixed, with a specially expressed curve of its fate (Hoffmann, Haberlin), with diversely expressed clinical syndromes. Applying ordinary clinical measures, we first of all do not see here all the peculiarities of the course and outcome of massive psychoses, and at the same time we note a fundamental difference from the so-called norm, a difference lying in the plane of revealing stable and fundamental qualities characterized by the inevitable presence in consciousness of irritation of the "self." It is precisely these peculiarities that relate to what Krepelin already spoke of as a mixture of healthy and disease-like traits in the personality. The genetic basis of such a mixture can be the "congenital weakness of the nervous system" (Hildebrandt), but by no means in the sense of any acquired changes of an organic nature or congenital organicity (for example, congenital syphilis). But whether this "congenital weakness" is at the same time an etiological moment - no answer has yet been given to this question. The matter is further complicated by the fact that it is hardly possible to speak of prepubertal P. Since we consider P. a special variant of character, we must draw certain conclusions from this position, namely: it is very difficult to speak of the prepubertal stability of character formations; no wonder Kretschmer notes in the prepubertal period the peculiarity of constitutional formations in the sense of their instability, low expressiveness; here everything is still in the stage of "formation." Finally, one more consideration of a clinical nature forces us, contrary to the prevailing opinion in Soviet literature (M. O. Gurevich, Sukhareva, Simeon and others), to speak out against the possibility of prepubertal P. It consists in the following: clinical observation of a number of cases shows that the diagnosis of P. in early childhood is erroneous and in later ages it has to be changed in the direction of recognizing a process disease (epilepsy, schizophrenia). There are also other types of errors in this case, when individual and episodic outbreaks, caused by the peculiarities of child development and the conditions of its course, are taken for P. Meanwhile, the soil on which such episodic superstructures occur should not necessarily be psychopathic; it is given by the very fact of the instability of the child's organism, which usually smooths out in the post-pubertal period of development. Thus, the question of the etiology of P. must for now be left open, however taking into account the facts of inheritance of a characterogenic nature and the presence of psychotic saturation and aggravation in the families of psychopathic personalities. The question of pathogenesis of P. is also not yet clear, as long as we remain in understanding P. on the positions indicated above. The matter appears significantly simpler if one takes the point of view of Berze or Bleuler. From their point of view, P. as such do not exist: what we accept as P. is nothing other than mild forms of psychoses (mostly schizophrenia). Bleuler directly states that the difference between a psychopath and a psychotic is only quantitative, rather based on the intensity of the process moment. Such a point of view "removes" the entire problem of P., and consequently a number of private questions arising from it. Clinical facts, however, sharply contradict this and indicate the presence along with psychotic pictures and psychotic-like pictures. The position of Berze and Bleuler receives its support from Kretschmer and his school, who in fact erases the boundaries between the ordinary variant of character (e.g. schizothymic), the psychopathic personality (e.g. schizoid) and the psychotic (e.g. schizophrenic). His establishment of two proportions - diathetic and psychesthetic - removes clinical practice from the walls of psychiatric institutions into life and introduces life into the framework of psychiatric clinical practice. The establishment and development of these proportions as if allow one to seek something real in the field of pathogenesis of P. And indeed, they give much that is valuable, especially where Kretschmer raises the question of the development and mechanisms of this development. For example, his "sensitive persecution delusion" consistently and deeply reveals to us the mechanism of the origin and development of the so-called paranoid syndrome. But here there is also a huge danger of completely erasing the boundaries between pathological, pathological-like and that which fits within the framework of the so-called norm. This erasure of boundaries leads to the fact that the particular regularities of the pathological are at the same time the regularities of the non-pathological. For example, sliding, according to Kretschmer, from the warm pole of sensitivity to the cold anesthesia, so characteristic for the emotional impoverishment of schizophrenics, is equally regular for cases lying outside pathology. It seems to us that here a gross error is committed by Kretschmer and his followers. Thus, von Rohden, starting from the positions of Kretschmer, directly correlates the act of social behavior with the peculiarities of somatics. On the other hand, Lange and Birnbaum, although in a less primitive form, correlate the genotypic with the same act of behavior and from this build the theory of the predisposition of the fate of the psychopath. Such an erroneous and reactionary position in its conclusions follows from the very understanding of the relationships between psychotic and non-psychotic. Kretschmer's position, for example, about the psychesthetic proportion, correct in many respects in its application to the psychotic, is partially correct also in its application to the psychopathic, but completely incorrect in its application to the non-psychotic. The antagonistic combination, for example, of sensitivity and anesthesia is not always present in the psychopathic personality. Such "bipolarity" has a different meaning from a pathogenetic point of view. If for the psychotic it is the result of the movement of the disease process, then in the psychopathic personality this "bipolarity" is determined by different character formations, due to the complexity and mixture of various paths and planes of development in this personality. That such an understanding brings us closer to the pathogenesis of P. is evident at least from the comparison and analysis of the obsessive-compulsive syndrome in an encephalitic patient, a schizophrenic and a psychopath.

In the first two cases, we are dealing with an organic violation of character, roughly of the violent type, while in the third case we will have to do with the same organic origin of obsessive-compulsive disorders, but conditioned by different causes according to the mechanism of manifestation, namely characterogenic in the form of the presence of a special kind of 'rumination' (Janet, Minkowski). Thus, the pathogenesis of P. remains unclear for now and can best be revealed through understanding P. as a special kind of development. It is self-evident that in the mechanism of appearance and development of one or another symptom complex, along with fundamental differences, there is also much in common with psychotic conditions. An example of this can be the fate of overvalued formations in a psychopathic personality and in a psychotic, or the tendency to actions of the short-circuit type in both. The basis of this commonality is the innate weakness of the nervous system apparatuses, mainly senso-motor ones (Exner, Kreidl), which serve as the basis for the development of one or another type of psychopathic personality, but by no means constitute the essence and specificity of this development. Clinic of P. If we are still unable to understand P. etiologically and pathogenetically, then clinically we have the opportunity to accumulate material by proceeding along the line of structural definition and delineation of individual syndromes. And here the first task is to establish more or less clear signs of differential differentiation between psychopathic and non-psychopathic conditions. The clinician's thought in this direction goes along two paths: 1) development of differential diagnostic signs along the line of demarcation of P. from all kinds of destructive processes, 2) development of differential diagnostic signs along the line of demarcation of P. from the ordinary variant of character. Demarcation of P. from destructive processes, of course, represents considerably greater theoretical and practical importance. Naturally, in this direction the most has been done. If we remain on the position of Kraepelin in understanding P., then their demarcation from destructive processes seems to be a very difficult matter. Indeed, understanding P. as ununfolded forms of psychoses, when specifying our clinical criteria, presents great difficulties in terms of differential demarcation of P. from mildly or sluggishly running destructive processes. The doctrine, for example, of schizophrenia mitis (Kronfeld), of inactive forms of schizophrenia (Berze), of mild forms of schizophrenia (Bumke), of asymptomatic schizophrenia (Gilyarovsky) and so on, expands the scope of this form of psychosis. But one could also not argue about words if the matter were only about this. In reality, in solving diagnostic problems, exceptional responsibility is placed on the psychiatrist. This all the more sharply poses the problem of establishing identifying points in relation to a psychosis with a destructive course. And here the only somewhat effective measure of clinical evaluation is the question of the course. Where we do not observe radical changes in personality, where there is no basis to speak of its impoverishment in one respect or another-there we will have to deal with a psychopathic personality that shows temporary intensification (of a quantitative nature) of the entire gamut of psychopathic traits or a certain group of them. Where there is basis to speak of changes, more or less steadily expressed, even if not reaching special intensity-there we are forced to recognize a process-destructive disease. From this side, the schizophrenic reactions described by Gannushkin, Krisch (Krisch.) and others should be considered. The criterion of course is decisive. The second identifying sign consists in the extremely subtly detectable symptom of 'understandability,' if we use the terminology of Jaspers (K. Jaspers). The detection of 'understandability' of one or another reaction, as Kretschmer correctly notes, lies in the ability to decipher the 'hieroglyphs' of the patient. One can understand these 'hieroglyphs,' but from this the patient does not cease to be a patient. The matter is about something else, namely about the adequacy, wholeness of the patient's experiences. Where we have to do with adequacy, wholeness, and not fragmentation, even if it is life-wise understandable, autonomization of separate systems and functions-there we will have to deal with a psychopathic personality. It is here that it seems to us essentially important to introduce the principle of constructing connections of personality in the sense of the subject's awareness of his uniqueness and commonality. Where this awareness of uniqueness appears detached from the awareness of commonality, where it grows into an awareness of exceptionalism and isolation-there we will have to deal with a pathological process. Where there is only a distortion of this complex formation of connections 'I-not-I,' in the sense of protrusion of uniqueness and exceptionalism-there we will have to deal with a psychopathic personality (Vnukov).- The third identifying sign can be the analysis of the experience itself (Kretschmer). Where we encounter paradoxicality, delays, coexistence of two affective series-there with a certain right one can speak of a pathological process. Bleuler very cleverly tries to explain this coexistence of two affective series, proceeding from the weakening, rather than loosening, of associative life.- The fourth identifying sign can be the presence of gross psychomotor and psychosensory changes in the form of forced grimacing, hypochondriasis, obsessive-compulsiveness with a character of foreignness to the patient's personality, primary hallucinatory experiences, etc.- The fifth identifying point can be the very character of autism in the sense of its primacy or secondaryity, i.e., in the sense of the history of its origin. For a psychopathic personality, autism, if observed, is usually a kind of psychological response to the situation; not so with the process patient. It is self-evident that these identifying points have some value only if they are taken in their connection, in the fullness of the clinical picture, and not in isolation. We have stopped for example on the schizophrenic process and its differentiation from P. Of course, what has been said about it also applies to other forms of organic diseases of the central nervous system. If we further try to demarcate P. from variants of character, then here we will encounter the following difficulties: 1) in psychiatric practice, the measure of a psychopathic personality will be the character taken in all its complexity (including here temperament and drives); this same measure also serves for ordinary characterological research, so in essence we do not have in our hands specific evaluations, except for very questionable ethical evaluations. Not without reason Isserlin notes that the decision on the quantitative side of one or another psychopathic personality is replaced by a purely characterological decision. This is undoubtedly so, and this is one of the reasons for the broad understanding of P. This is especially evident in the criminal material, where due to such a substitution of evaluations the ordinary percentage of psychopathic personalities, reaching 15-17 according to Gaupp, soars to 37 (Krasnushkin). This broad understanding of P. leads of course to the 'washing out' of the specific in them. It turns out that a significant part of society-psychopaths. This by no means corresponds to reality. We are forced, for the purpose of a truly scientific understanding of the question, not to forget the basic position of Kraepelin that a psychopathic personality is a complex interweaving of healthy and pathologically-like paths of development. It is this complexity that constitutes the main watershed between such personalities and variants of character. The clinical picture of a psychopathic personality does not fit into Procrustes' bed of a 'one-plane' understanding of it. We always encounter an extraordinary entanglement in the structure of a psychopathic personality, an entanglement caused by the presence of a number of contradictory qualities and properties, which however do not define this personality entirely, from which grows the representation of it as partially infantile. From this grow the peculiarities of development of a psychopathic personality, finding their expression in the peculiarities of the life curve of the psychopath.-2) In the same demarcation another difficulty arises, namely the demarcation of a psychopathic personality from the so-called neurotic. On this question there are two diametrically opposite points of view. The majority of modern researchers (Weizsacker, Bumke and others, and in our country Gannushkin, Yudin, Vnukov) stand on the point of view of the unnecessaryness of isolating neuropaths from the group P. After deducting from the group of so-called neuropaths the vegetatively-stigmatized ones (Bergman), all the rest is psychopathic with only the emphasis that the reactions of these personalities have a narrower, somatic character. On the opposite point of view in our country stand Yushchenko, Emdin, and historically this point of view was defined by Freud and his school (see Psychoanalysis). All the above leads us to the fact that at the present stage of understanding P., the main clinical task consists in identifying and structurally demarcating certain syndromes. This syndromological grouping of P. can be conducted according to various starting points. Most often it is conducted as a portrayal of individual images and types.

We have such an attempt in Kurt Schneider, who establishes 10 types of psychopathic personalities: hypertimic, depressive, restless, fanatical, seeking recognition, labile (reactive labile of Gurevich), explosive, anethic, weak-willed, and asthenic. This clinical typology of P. repeats on a more extended basis the grouping of Kraepelin. Ultimately, Schneider remains on the positions of a 'sociological' understanding of P., putting the act of behavior as the basis of his typological attempts. In this connection, it would not be amiss to recall the witty and correct remark of Bumke that we shield the personality with biological screens and assume that this accomplishes everything. Our typological labels are still nothing more than screens behind which everything remains in its place. In recent times, this typology of forms is filled with either characterological data (Grule) or data from the doctrine of reactions and constitutions (Kretschmer, Ewald). For a number of particular questions, this moves us forward, but fundamentally new these attempts do not bring. In his work on psychopathic personalities, which is a summation of all our clinical experience, E. Kan attempts to expand the number of types of psychopathic personalities to 16, including here psychopaths inclined to obsessions, fears, and eccentrics; modifying Schneider, he still repeats him. The psychologist Klages remarked on this that with the same right one could expand the number of types of psychopathic personalities to 20, 30, etc., from which he draws the conclusion: there are no psychopathies—there is psychopathy. The diversity of types is equal to the diversity of characters. Is this so? The clinical facts serve as an answer to this question, categorically refuting this assertion of Klages. The course of P. itself indicates features lying not only in the characterological series but also some others, arising from the mixing of heterogeneous characterological formations in psychopaths and having as their basis the weakness of certain physiological systems and structures. This alone justifies attempts at clinical typology of P. In this direction, much has been done by Gannushkin, who singled out the schizophrenic type of reaction (properly the schizophrenic constitution in contrast to the process) and acute epileptoid states, and thereby giving an example of clinical analysis and typology of P. In the same direction, one must not overlook what has been done by Bonhoeffer, and after him by Birnbaum, in terms of accentuating attention on the episodic outbreaks in various psychopaths. These temporary and transient psychopathic states occur on a certain soil and again testify to the peculiarities of development of the psychopathic personality depending on the uniqueness of its structure and life tempo. That is why it seems not uninteresting from a clinical standpoint to sharpen the concept of development, which in the psychopathic personality plays, in contrast to the psychotic, a dominant role. And here it is necessary to distinguish the following types of development: essential (proper development), phasic and episodic and reactive. Gannushkin still adds to this 'shock' development. Such a distinction makes it possible to understand the psychopathic personality in its dynamics, while the layout of the structure of the psychopath is in general determined by the connection of individual characterological formations. That is why it would be more cautious for now to go the syndromological way, singling out individual few but fundamental syndromes in connection with a certain neurosomatic weakness of certain systems. Going the indicated way, one should stop at the most typical representatives of the group P. Among these latter, one of the central places is occupied by the type of so-called paranoid development, characterized mainly by a peculiar blend of naivete and rigorism in the presence of sharp and constant affective tension of thought. These people usually experience a very unusual fate. They are often sterile inventors, striving with passion and tension for recognition of the value of their inventions. They are ardent seekers of a subjectively understood 'truth'; they are usually people with a character of deficiency in experiences, shifting the blame for their failures onto others. In connection with the described character of their pursuits and their fate, the constitutional bases of the personality are far from being sharpened uniformly: depending on a series of conditions accompanying such development, in the personality there appear at times moments of struggle, at times moments of dreaminess and 'waking sleep.' These people are rigid in their psychic life, and once an experience has filled their psyche, it holds fast and firmly, subjugating the entire personality, creating for it false goals and meaning (i.e., super-valent formations, according to Wernicke). The fate of these people is entirely filled with conflicts and struggles, often leading them to litigation and making them 'persecuting persecutors,' ardent disputants and intriguers, going through life in the shell of 'principledness,' but in reality striking by the poverty of broad goals and tasks, subjectivism and pathological distortion in their searches for 'truth' and 'justice.' It is extremely important to note that the affective involvement of such people in their experiences can make those around them succumb to their passionate suggestions. Such people can become at the head of sects, rallying around themselves a core of most devoted followers. At the other pole there is no less interesting and colorful part of P., characterized by extraordinary boldness and the fantasy of their flights. In some cases, such people themselves believe in the castles in the air they have built; in others—they make those around them believe. Kraepelin with a certain cruelty and roughness called them fantasists, knaves, and swindlers. In the main this is so, but the whole point is that these fantasists and mythomaniacs in the majority of cases turn into 'knaves and swindlers' under the influence of a certain circle of development. These Khlestakovs grow only on a certain nutritive soil. Their main features are: superficial talent, aversion to systematic and persistent work, frivolity and carelessness, establishing by them an easy and rapid contact with others in the presence of a certain affective coldness in these relations, a sharply expressed inclination to inventing non-existent events. They pass themselves off as those who in their imagination can impress others with the effect of their name, title, fate, etc. This type of development we would call the type of social parasitism. It should be noted that, being exposed, these people comparatively quickly give up, become lost, and self-expose. They are inclined in acute situational positions to give anomalous reactions with the character of false dementia, childishness (puerilism), hysterical reactions of the Ganser type (see Ganser's symptom), with a peculiar change in consciousness with the character of displacement of unpleasant and traumatic experiences, persistence in their claims to the right to illness. Along with the indicated types of development, one should still stop at the so-called asthenic development (Adler, Gannushkin), in which in people with a reduced life tonus, inclined to certain fluctuations in mood with a predominant coloring of the latter in the tones of gloom and hopelessness, there arise prolonged states with the character of experiencing their own worthlessness. These people are characterized by anxiety, suspiciousness, excessive sensitivity. Due to the latter, they are as it were walled off from others. In reality, however, they passionately seek participation in life, which however pricks them with its sharp corners. Under the influence of a number of circumstances they fall into despair, giving thereby a series of 'neurotic' reactions, usually proceeding by the mechanisms of conditioned connections. Due to their anxiety and excessive sensitivity, these people are distinguished by extreme instability of mood tonus, instability of life tempo, the ease with which they hide in their shell, from which they with envy and painful anxiety observe the surrounding. A whole series of somatic phenomena as a rule accompanies the reduced tonus of their life activity. Here are persistent complaints of headaches, easy exhaustibility and fatigability, sweating, anxious and non-refreshing sleep, loss of appetite, occasionally indigestion, painful sensations in the region of the heart, etc. Finally, in contrast to these soft sensitive people is described the type of P., in which the power of primary and primitive impulses predominates. As a rule these are people with a tendency to impulsiveness, stormy manifestation of affect, with rapid motor discharge, persistent and inextinguishable, with the character of violence, striving for the realization of deeply laid drives and interests, which usually flare up instantaneously. Here belong dipsomaniacs, people with sadistic inclinations, with incontinence of affect, with stormy and swift manifestation of their desires. A number of authors as an example of such a type of P. bring cases of lust murders (Lustmord).

Even if one does not adhere to this last position, it should still be emphasized that these individuals of drives, by the mechanism of their reactions, closely resemble either epileptics or cold schizophrenics. Two types of development closely approach this type: a) so-called sexual psychopaths with various perversions and the dominance of sexual drives in consciousness, b) drug addicts with a character of addiction according to the type and mechanism of conditioned reflexes and the dominance in consciousness of the drive for various narcotics. Within each of the described types of psychopathy, there exist a series of transitions and shades, determined by the very structure of the psychopathic personality, the intensity of development of its individual components, and the stability of the formation of conditioned bonds and connections. Conventionally and schematically, one can accept the division of all existing psychopathies into three circles: cycloid, schizoid, and epileptoid. But in this, one should remember that this schematic division by no means determines the content of a given type of psychopathy, just as it cannot show the specificity of its development. This division only makes it possible to establish the conditional and external relationship of one type of psychopathy or another with one or another nosological unit of massive psychosis. Prognosis and prevention of psychopathies. From what has been said, it is clear that since psychopathies represent, in essence, a special characterological blend, one should speak of their stability. In this regard, a prognosis based on characterological analysis, and taking into account the basis of congenital weakness of certain neuro-somatic structures (mainly structures of sensorimobility), should be considered unfavorable. But this does not deprive us of the possibility of evaluating favorably certain psychopathic outbreaks or reactions, the course of which is determined not only by the mentioned factors. And indeed, clinically we evaluate certain psychopathic reactions comparatively favorably. The basis of a favorable prognosis lies in the peculiar curve of movement of the psychopathic personality. And this peculiarity is determined by the life organization of this personality. It is characteristic that such reactions, no matter how long their duration, are removed by a number of general favorable conditions. Our era of building socialism is brilliant proof of this. And further: the general crisis of the capitalist system, shaking the foundations of daily life, instilling uncertainty in the morrow, cultivates, cherishes, and determines the growth and extent of psychopathic outbreaks and reactions of the type of confusion, embitterment, melancholy, etc. In the mixing of reactions with the structure of the psychopathic personality lies the basis of the widely spread error about the specific 'criminogenic' nature of psychopaths, about their inborn 'social danger'. These theories, reviving, willingly or unwillingly, the doctrine of Lombroso, are reactionary precisely because of the distortion of clinical facts, the search for specific connections where they do not exist. Naturally, these theories represent the consolidation of class interests of the bourgeoisie, which must transfer the contradictions of the system and structure into the personality, thereby making them eternal, given 'from God and forever'. The preventive struggle against psychopathic outbreaks in general is a conscious class struggle with certain goals - to reorganize society on socialist principles. This struggle is primarily the creation of human conditions for the development of the personality, the elimination of causes that aggravate this constant irritation of the psychopath's consciousness by the feeling of 'I', given either in a hypertrophied form or in a hypotrophied one. Finally, this struggle consists in finding socially useful goal systems, along the channels of which the psychopathic personality compensates for its congenital weakness. Here opens up a wide field of activity for the psychoghygienist, who, participating in the rationalization of the regime of labor and life, contributes to the correct and prolonged inclusion of the psychopathic personality in life. The era of building socialism provides all the necessary conditions for the true removal of psychopathic outbreaks and thereby certainly creates the firmest foundation for the true healing of the psychopathic personality, for the mobilization of its healthy resources.