Studies in Forensic Psychiatry | Page 4

delusions appear,
and the prisoner becomes especially taken up with ideas of unknown evil powers, of
demons and spirits, and of being persecuted and possessed by the devil. Simultaneously
they complain about all sorts of bodily sensations. In isolated cases one may observe
convulsive twitchings of the voluntary and involuntary musculature. Finally severe motor
excitements set in. The patient becomes noisy, screams, runs aimlessly about, destroys
and ruins everything that comes his way. With this the disease has reached its height. At
this stage consciousness is entirely in abeyance and the disorder is followed by complete
amnesia." Reich supposes that this acute prison psychosis may be included in that large
group of abnormal psychic processes, developing from affect and affect-like situations.
Reich's important work remained the only one on the subject until 1888, when Moeli
again called attention to it. Moeli[4] spoke of patients in whom an apparent total blocking
of all thought processes took place. They would exhibit complete ignorance of the most
commonplace facts, would forget such well-known things as their own name, place of
birth, or age; were unable to recognize the denominations of coins, etc. He noted,
however, that although the answers these patients gave were false, they had a certain
relation to the question. For instance, coins of a lower denomination would be mistaken
for higher ones, postage stamps were called paper, etc. They also showed a marked
tendency to elaborate all sorts of false reminiscences about their past life. Along with this
failure of the simplest thought and memory activity, these individuals were otherwise
well-ordered and behaved.
The reader will at once recognize in the above description the well-known Ganser
symptom-complex, the several variations of which have been so frequently discussed of
late years. Ganser[5] further showed that these cases frequently evidenced vivid auditory
and visual hallucinations. At the same time there existed a more or less distinct clouding
of consciousness, with the simultaneous presence of hysterical stigmata, especially total
analgesia. After a short time recovery took place, the patients suddenly awoke as if from
a dream and evidenced a more or less complete amnesia of the events which had
transpired.
Numerous discussions concerning this disease-picture have appeared of late years in
literature. The Ganser syndrome, or twilight state, has been enlarged upon, and several
variations of this condition have been isolated. The chief contention, however, of the
various authors on this subject seems to be whether this symptom-complex should be
considered as hysterical or whether it should be placed among the large group of
degenerative states. Both views are ably defended by prominent psychiatrists. I have
recently observed the Ganser syndrome in an undoubted case of toxic-exhaustion
psychosis.
Raecke[6] designated this disease-picture described by Moeli and Ganser as an hysterical
twilight state in psychopathic individuals. These conditions were developed in them as
the result of emotional excitement in imprisonment. The constant hearings, the confusing
cross-questioning, the fear of punishment, finally the injurious effect of solitary
confinement, shock and weaken the slight mental tension of the prisoner to a marked
extent. As a result of this, we have on the one hand a condition of apathy, of inability to

concentrate the mind, of incapacity to think and of a sort of feeling of being wholly at sea,
accompanied by vertigo and other nervous manifestations, while on the other hand the
physical despair, the obstinacy of the prisoner, now increase to pathological maniacal
attacks, now again are changed to stubbornness, mutism, with refusal of food. At the
same time the more or less constant wish to be considered sick, and in consequence to be
freed from imprisonment (and in this we see perhaps the hysterical component), may
influence deleteriously and in a peculiarly modifying way the disease-picture. The
various questions put to the patient by the examiner may act as so many suggestions.
Raecke further calls attention to the manifold similarities which these conditions may
show with catatonic processes. In these hysterical twilight states, quite aside from mutism,
negativism, and catalepsy, peculiar mannerisms were noted, a sort of affected, childish
way of speaking, motor stereotypies, swaying of the head, running in a circle, queer
actions, and sudden expressions of senseless word combinations. In a later work
Raecke[7] describes a symptom-complex, which he designated as "hysterical stupor in
prisoners", and in which the catatonic symptoms exist in a still more pronounced manner.
The severe forms of this disorder, which may extend over weeks and months, are liable to
be confused with progressive deteriorating processes, especially so because those
symptoms which were wont to be considered by many as positively unfavorable
prognostically, may be found here in very deceptive imitations. Thus the affected, silly
behavior, impulsive actions, temporary verbigeration, senseless word salad, grimacing,
stereotypy, attitudinizing, etc., which these patients exhibit, may easily be mistaken for
the typical catatonic