In Poland we have at present in towns 29 detoxication centres with 1,226 beds; people found by the police in public places in a state of intoxication are more and more often taken to detoxication centres instead of being arrested and taken into custody (a stay in a public place in the state defined as state of drunkenness is in Poland not subject to penalty). Between 1966-1972 from 60 to 70% of those arrested for drunkenness were throughout the country sent to detoxication centres and not taken into custody. The average annual number of men placed in the Warsaw detoxication centre in the years 1968-1970 amounted to approximately 27,550 and that of women to 1,500. The number of men taken to the centre for a second time during the course of a year amounted to approximately 4,200, and three or more times – 4,500; the number of women placed in a centre for the second time during the course of one year amounted to approximately 200, for the third time or more – to approximately 500. The category of individuals taken to a detoxication centre several times during the course of one year thus is substantial. There were 32%  of men with a least two such stays, and 40% of women from among the total number people taken to the centre. This category of individuals is called habitual drunkenness offenders, which, as we know, exists in many countries. Selected as a sample for the studies, discussed here were not individuals who had repeatedly been taken to the detoxication centre during the course of one and the same year. The idea was to eliminate those individuals as to whom we were sure that they were alcoholics. The research, conducted in 1970 in the detoxication centre in Warsaw by the Department of Criminology of the Polish Academy of Sciences embraced that category of men who during a period of over five and a half years were at least three times taken there and the category of women who during the period of five and a half years were taken there at least twice. Each individual, listed in 1970 by the detoxication centre, in the order they were entered in the book, was checked from the beginning of 1970 in the centre’s records for the past five years (1965-1969) and in such a way material was completed on 500 men who during that period had at least been sent there three times and on 250 women sent there at least twice. Among men taken time and again to the detoxication centre there is a large percentage of older people, because in 1970 as many as 50,5% were over 40 and a mere 11.4% were below 30. The median age of these men amounted to 40.2; we find, as is known, similar figures in publications dealing with the problems of alcoholics. Those taken only three times to the centre amounted to approximately one-fourth of the total number of men, those taken 4-6 times accounted for 37%, 7-9 times – 19% and 10 or more times – 20%. Among the latter category of 98 patients of the centre 52 were taken there 10-15 times, 26 – 16-20 times and 20 – 21 times and more. As results from the above those who were only 3-6 times registered by the centre constitute 61% of the total number, and without taking into account additional data about arrests by the police of the people whose state of intoxication did not require their isolation in a detoxication centre, the true picture of the extent of deviations in the behaviour of the investigated, caused by intoxication would be distorted. That is why the decision was taken to add to the data related about the frequency of stays in the detoxication centre additional data on arrests by the police of men in a state of intoxication, who had been already registered in the centre three times, four times, six times and 8-9 times; it was not considered necessary to introduce analogical procedures for those listed many times during that period in the centre – from 10 to over 21 times, since it is to be assumed that these as a rule are already alcoholics. Taken into account in this respect was not only the period between 1965-1970, but also later years between 1971-1973, in order to find whether excessive drinking of alcohol by the investigated, causing police intervention, did not get worse. It turned out that only with men registered in the centre three times the percentage of those arrested additionally by the police did not surpass the figure of 33, but with those listed by the centre four times – it already amounted to 48%, six times – 55% and 8-9 times – 53%. This shows that beginning with 4 stays in the centre the percentage of people arrested by the police because of drunkenness already amounted to at least approximately 50%. Taking into account the number of arrests, figuring in police records, it was found that those arrested at least 5 times there, were in turn among those listed in the detoxication centre 3, 4, 6 and 8-9 times: 10%, 30%, 32% and 47%; of those listed 10 and more times: 0, 15%, 14%, and 27%. Thus the studied material is the subject of substantial differentiation if, in addition to stays in the detoxication centre, one takes into account arrests by the police and the number of such arrests. Taken into account additionally were court convictions which makes it possible to answer the question, how many men listed in the  centre until the end of 1973, were neither arrested by the police nor convicted by a court for offences, as a rule committed in a state of intoxication. Of such former patients of the centre, without the behaviour patterns, referred to and connected with excessive drinking of alcohol, there remained at the end of 1973: among those listed in the centre 3 times – 44%, among those listed in the centre 4 times – 38%, among those listed in the centre 6 times – 25%, among those listed in the centre 8-9 times – 31% . Distinctly noted was an intensification of deviations in the behaviour in a state of, intoxication in the examined individuals during the course of the last three years (1971-1973). At the end of 1973 over 50% and 60% of the investigated with previous 3 and 4 stays in the centre and approximately 70% beginning with 6 stays in the centre, may without any special objections be considered alcoholics. It should, however, be borne in mind that there exists a large category of alcoholics whose systematic drinking alcohol to excess does not cause a behaviour that requires the intervention of the police and that is why, in regard even to these individuals among the investigated with whom, in addition to frequent stays in the detoxication centre, no other additional negative features were noticed, the suspicion that they may be alcoholics, is nevertheless justified. In this study under discussion here, during which no individual, psychological and medical investigations or environmental research were carried out, these problems could not be properly clarified. 82% of the men who more than once were brought to the detoxication centre were blue-collar workers and only 8.5% – white-collar workers. 63% had regular jobs and 31% worked from time to time or did not work at all (information regarding work is, however, not based on reliable data). The percentage of those who are not working (and those working from time to time) increases together with the number of stays in the centre; amounting to: 18% of those listed three times in the centre, 22% – 4-6 times, 39% – 7-9 times and 55% – 10 times and more. 50% of the men were not convicted by courts, 20% – were once convicted, 16% – 2-3 times and 14% – 4 times and more. Together with the growing frequency of being registered in the centre there also grows the percentage of those convicted by a court   from 42% (3 times listed in the Centre) to 66% (in the group listed 10 times and more). 62% of the men registered in the centre as “not working” were convicted by a court, 69% – of those working from time to time and 40% – of those who were working regularly. Studying the group of men who had been convicted it was found that the late beginning of convictions, only when they were already 30 and more, is found with 31% of those convicted who are 30-39 years old and with as many as 65% among those who are 40-49; in the group with convictions when 50 and older – the first convictions occurred after 50 with all of them. Among the total with convictions only 18% were first convicted when below 21. However, among those offenders who were first convicted at the age of 17-20 we find the largest percentage (4l%) with later convictions amounting to 4 and more. Markedly smaller numbers of the men over 40 have been convicted than is the case among the younger age groups (p < 0.001). However, the percentages of recidivists, convicted 4 times and more are similar in the various age groups, beginning with the age of 30. The above-mentioned data testify above all to the fact that the majority (70%) of men listed time, and again in the detoxication centre, whose median amounted in 1970 already to 40.2 years, either had not previously been convicted at all (50%) or had faced charges only once (20%), while the category of recidivists with multiple convictions is not numerous (14%). The results of studies also testify to the fact that approximately 45% of the total number of those convicted, faced charges for the first time only when they were already 30 years old. Dealing with data on the delinquency of those convicted by a court once and 2-3 times, it was found, that in the structure of their delinquency offences against property did not surpass 22% and 23% of all the offences committed, and offences with physical or verbal aggression and other offences, as a rule also caused by insobriety, amount respectively to 68% and 60% of the committed offences. Among a small group of recidivists, convicted at least 4 times, only 45% of the recidivists committed mainly or exclusively offences against property (larcency), while in the case of 48% there dominated offences with physical and verbal aggression. To the typical offences, with physical aggression belong acts that are not particularly dangerous, such as slight bodily injury, “il-treatrnent of family members” and assaults upon policemen. Within the group referred to above only a very small sub-group of the recidivists with multiple convictions, who committed mainly aggressive acts caused by insobriety, can also found crimes in the form of more serious aggressive acts, such as robbery, serious bodily injuries, brawls, combined with the use of a dangerous instrument. Despite this, even among recidivists with severe degradation there is only an insignificant number of such recidivists who committed at least four offences combined with physical aggression ‒ there were only 7 out of 67 ‒ 10.4%; they constitute a mere 2.8% of the total of convicted persons. The group of recidivists with severe degradation and at least 4 convictions accounts for no more than 28% of the total number of those convicted; the deliquency of the remaining men who are frequently listed in the centre is rather a marginal phenomenon. During the past three years (1971-1973), side by side with the intensification of alcoholism there could be noticed among the investigated an increase in the percentage of those with convictions in the group listed 3 times in the centre from 42% to 49%, in the group listed 4 and 6 times from 44% to 57%  and 62% and in the group listed 8-9 times from 53% to 62%. But the structure of the offences did not undergo any changes ‒ petty offences, that socially are less harmful and caused by insobriety, predominate. Out of the 250 women, listed at least twice in the detoxication centre during the period of 5 and a half years, have been set apart 128 women noted in police records as prostitutes (P) and 122 women about whom such data were lacking (NP). 70% of the P were listed at least 4 times (32% ‒ eight  times or more). 60% of the NP were registered only twice (14% at least 8 times). The prostitutes are younger than the remaining women ‒ the age median of P arnounted to 35.4 years, that of NP ‒ 42.3 years. 48% of the women with the symbor “P” were below the age of 35 years, 24% of the NP. Among the NP as many as 30% were already 50 years old and more (among the P 13%). Those who are not prostitutes thus are considerably older, but among the prostitutes, too, are women from the age groups above 35 years. (Note that while in 1970 there were among the total number of prostitutes, known to the police throughout the whole country, 44% who were at least 31 years old, as many as 73% of the studied prostitutes registered in the Warsaw detoxication centre were at least 30 years old). Prostitutes were often arrested by the police because of drunkenness – only 30% were arrested less than 10 times, 34% from 10 to 29 times and 27% ‒ 30 times and more. Only 32% of those who were not prostitutes were arrested during this same period because of drunkenness, in the following 3 years (1971-1973) ‒ 34% and among the total of the arrested 56% were arrested only 1-2 times and a mere 22% ‒ 10 times and more. Women listed time and again in the centre have much worse data related to education and work than men, listed there from time to time. Among P there were 20% of women with incomplete primary school education, and NP ‒ 39%; 69% of the women had no trade, including P and NP; not working (or working only from time to time) were 72% of the P and 60% of the NP. Data regarding convictions testify to the fact that 64% of those who were not prostitutes had no convictions and only 6% NP were convicted by a court four and more times. Only 28% of the prostitutes had no convictions, 22% were convicted once, 20% ‒ 2-3 times, and 30%, four times and more. The first convictions at an age below 25 were found with 40% of the prostitutes and only with 11% of the NP, 31% of the P had their first conviction at the age of 30 and 7l% of the NP. Those who were not prostitutes as a rule had no convictions and among the few who had faced charges, the beginning of delinquency took place only after 30 (with approximately 30% ‒  only after 40). In the delinquency structure of P as well as NP larcency constitutes only 36% and 33%; undoubtedly this mainly means stealing from men. Most of the offences committed by P and NP are not serious. The material about women obtained from the detoxication centre points to their marked social degradation, probably reaching back to the period preceding their turning into alcoholics and also indicates the deepening of their social degradation, together with age and the intensification of their alcoholism.   *   The results of the research under discussion testify to the fact that the majority even of those who were registered less than 10 times during those five and a half year in the detoxication centre, are certainly already alcoholics. Studies revealed that in addition they had been frequently arrested by the police for drunkenness (though not isolated in detoxication centres) and had faced courts, charged with typical offences for people drinking alcohol to excess. Thus, even less frequent stays in a detoxication centre should already be an indication for the health and social care service to intervene, in order to find alcoholics requiring treatment.

No abstract

Problems of reactive mental disorders and of the simulation of mental disorders have lately been very poorly represented in both psychiatrist and criminological literature. The present contribution discusses the sources of a considerable number of difficulties which emerge in practice when discussing the question of “Reactive disorder or malingering?”, as well as the errors of diagnosis in diagnosing malingering. The contribution is based on a analysis of material which comprizes three hundred and fifty cases of reactive mental disorders, and ninety-nine cases of malingering (simulation), with the accused; such material has been obtained from the Department of Forensic Psychiatry of the Psychoneurological Institute and from fifteen mental hospitals in Poland, to which prisoners were sent for observation. When making use of the term of “ malingering” , the contents of that notion ought to be narrowed down so as to comprize behaviour of such kind, which consists in an individual who is not mentally ill consciously producing definite psychopathological symptoms. We could not possibly consider to be malingering in the true sense of the word the producing by a mental patient (e.g. one suffering from schizophrenia) of symptoms which are not characteristic of the disorder in question. What is described by the term of sursimulation, even though it contains elements of malingering, essentially differs from true malingering. On the other hand, the view is not correct which reads that we may only then speak of malingering, when the simulating of symptoms of mental disorders makes its appearance with persons who do not exhibit any abnormal traits. Malingering most frequently makes its appearance with prisoners who exhibit symptoms of psychopathy, encephalopathy, mental deficiency, etc. The problem of metasimulation deserves special attention. The fact that at a given moment we have to do with a behaviour which indicates malingering is not by itself evidence that previously, during the period immediately preceding such malingering, reactive disorders did not appear with same prisoner. The symptoms of reactive disorders during the period which preceded the sending of the prisoner to a mental hospital may have become almost entirely extinguished, while their place was taken by an attitude of malingering, greatly reminiscent of the recent symptoms of reactive mental disorders. Besides, in cases of that kind there also arises, as a rule, the question of whether, side by side with elements of malingering, there do not appear feebly marked symptoms of reactive mental disorders, as remnants of the reactive disorders from which the patient had previously been suffering. Neither should another difficulty, which jurisdiction finds in its path, be forgotten. When having to do with an attitude of obvious malingering, one ought to take into consideration the possibility of malingering being gradually transformed into reactive disorders. The mechanism of malingering becomes fixed in the prisoner’s mind, it undergoes automation, and sets into motion a hysterical mechanism, which, in its turn, acts independently, in the way proper to it, owing to which psychogenic disturbances arise. Such a state as that cannot be described as malingering, in spite of the fact that it was simulation that not only constituted the starting-point of the disorders arisen, but had actually provoked, and to some extent moulded, them. An individual in that state no longer exercises any control over the symptoms of reactive disorders which have appeared, he ceases to exercise any mastery over them; the former malingering mechanism has been driven out of his consciousness and has become transformed into a new, and considerably more complicated hysterical mechanism. The cases discussed above may still run a course complicated in another way, namely after the transformation of malingering into reactive disorders certain symptoms of the latter in their turn are subject to undergo, even after the extinction of the disorders, a conscious consolidation through the new manifestation of the malingering mechanism. Therefore in such cases malingering may be observed, not only at the beginning, but also after the recession of the state of reactive disorders, in the form of metasimulation. The mechanism of the arising of reactive disorders is analogous to that of the arising of malingering; at the basis of both the above mechanisms there lie certain common fundamental tendencies. In all probability malingering runs along the very same tracks as hysterical reaction, and mobilizes, through the intermediary of autosuggestion, analogous mechanisms, causing, as it were, the automation of certain attitudes. Malingering individuals, even though at first they control that mechanism and consciously steer it, may lose their control over it. This leads to the cases of a transformation of malingering into reactive mental disorders, discussed above. The knowledge of making use of a mechanism approximating a hysterical one, of producing and fixing certain symptoms which would constitute a good imitation of disorders, is — as is well known — a most difficult thing. This is why long-lasting and consistently carried out malingering is an extremely rare phenomenon. An individual who simulates in such a way must be equipped with peculiar features, in order to be equal to tasks of that kind. Hence the well-know saying that “ one can simulate well only that which is close to the simulating persons’s individuality” (Lassegue), and that “ a good malingerer must be born such” (Braun). Among psychiatrists there prevails, generally speaking, an agreement as to the view that long-lasting and consistent malingering happens, as a rule, only with persons whose personality exhibits clearly pathological features. The data obtained from sixteen mental hospitals for the period of 1953 — 1960 bear witness to the fact that, out of 5,967 male prisoners sent there for psychiatric examination, mental reactive disorders have been found to exist with 711 cases (11.9 per cent.), and malingering of mental disorders in a mere 99 cases (1.6 per cent.). In the case of the 793 women, sent from prisons to mental hospitals for psychiatric examination, reactive disorders were found to exist in 73 cases (9.2 per cent.), and malingering in a mere 7 cases (0.9 per cent). When we analyse the 99 forensic-psychiatric reports which diagnosed malingering, it appears that we may distinguish two different groups of cases among them. The first of them comprizes 70 prisoners,, with whom the diagnosis of mere malingering does not arouse any essentia] diagnostical reservations. On the other hand, in the second group, which comprizes 29 cases, we have to do with 19 cases of undoubted metasimulation, as well as with 19 cases which are doubtful. Doubts arise in connection with the possibility of the co-existence of reactive disorders with simulation (5 cases), as well as with the presence of reactive disorders during the period immediately preceding malingering (3 cases), or finally, because of data which speak in favour rather of reactive disorders than of malingering (11 cases). Thus it is only in seventy cases that the diagnosis of malingering does not arouse any serious doubts; neither should it be forgotten that, at the same time (i.e. during the same seven-and-a-half-year period) as many as 711 cases of reactive mental disorders were observed with prisoners in sixteen mental hospitals. Thus cases of malingering of long duration are an extremely rare phenomenon in forensic psychiatrist practice. For the purpose of establishing how do the data look which concern long-term malingering of mental disorders in prisons, data concerning the number of cases of malingering within the period of one year have been obtained from the psychiatrists employed in two large Warsaw prisons, which are, in principle, destined only for prisoners under investigation. It was found that the number of malingering prisoners amounted, in one prison to nine, and in the other to five. Taking into consideration the number of all the prisoners detained in those prisons in the course of twelve months, the “ co-efficient of malingering” , calculated as per one thousand prisoners, amounts to 1.86 and 0.96 respectively. After a correction has been introduced, because of the possibility of certain prisoners failing to report for examination, that co-efficient should not exceed 2 pro mille.[1] Among the 350 cases of reactive disorders, selected by lot out of the total number of reports with a diagnosis of “ reactive disorder” for the purpose of obtaining a representative sample, metasimulation during the period of clinical observation has been stated to take place in as many as 24.8 per cent, of the cases.  When examining the two groups of cases: those of “ pure” malingering and those of metasimulation, we can establish the essential differences which exist between them. Those prisoners with whom no reactive disorders have been found to exist during observation, simulate other symptoms of psychotic disorders than those prisoners, with whom malingering has made its appearance only after the extinction of reactive disorders in hospital.   In the group of the seventy “ pure” cases of malingering the most numerously represented is the simulation of memory defects and of mental deficiency, or else of dementia; apart from the above, prisoners also simulate symptoms of conversion hysteria, of hallucination or delusion, as well as, exceptionally, symptoms of stupor.  On the other hand, in the group of fifty cases of metasimulation, more than one-half of the total number consisted of prisoners who simulated symptoms of pseudodementia along with elements of puerilism (which were altogether absent from the group of “ pure” simulation). Of cases of con- fabulation with symptoms of pseudodelusions there were eight, while there were none of them in the “ pure simulation” group. Of individuals who simulated memory disorders there were three times less.  Deserving of particular attention are the twenty-six cases of “ pure” malingering, in which the whole manner of simulating, the contents of the pseudo-symptoms produced, and the prisoner’s entire behaviour are of such a kind, that it seems improbable that the simulating individual could suppose that he would succeed in deluding his environment. The attitude of such prisoners is one of playful contradiction, usually coupled with irony and mockery with regard to the medical personnel; their behaviour is characterized by elements of acting and indeed of clowning; the absurdity of their utterances is glaring. Periodically, however, states of a certain inhibition make their appearance, and from time to time sudden changes of mood are visible, considerable tension, violent attempts at aggressive behaviour, and tendencies to self-mutilation.  It was Mönkenmöller who, once upon a time, drew attention to that peculiar form of malingering, in which it is impossible to detect any intelligible purpose. In such cases malingering assumes the character of acting which gives the malingerer some satisfaction (“spielerische Simulation' 4, as Utitz called it); The picture of malingering gives one to think by its specific features, and is distinguished, from the other types of malingering, by its altogether exceptional primitivism and inconsistency. 92 per cent, of the prisoners who simulated in that way were recidivists with a considerable number of previous convictions to their names. In the anamnesis of nearly one-half of them alcoholism and brain trauma, as well as other chronical brain diseases, made their appearance. More than one-half of their total number have performed self-mutilation in prison. In the cases of “pure”, true malingering there appear, in the hospital material investigated, numerous prisoners with symptoms of encephalopathy (37.1 per cent.) and psychopaths (about 40 per cent.), as a rule described as impulsive, irritable, aggressive. Not a single malingering prisoner has been qualified as an individual with a normal personality. The prisoners who simulated mental disorders are recruited — 81 per cent, of them — from among recidivists, as a rule from among juvenile or young offenders: sixty-six per cent, of the investigated were under twenty-five years of age. They belonged to the category of offenders who commit common offences, mostly offences against property, with thefts predominating. Among the reactive mental disorders to be met with in forensic psychiatrist practice and in the prisons, two kinds of disorders may be distinguished. First of all, the group of disorders of the type of hysterical disorders, the majority of which has a more primitive character; they are: pseudodementia, Ganser’s syndrom, puerilism, states of incomplete stupor and of stupor, fancies with contents similar to those of delusions, and symptoms of conversion hysteria. It is precisely that category of disorders that oftentimes causes particular difficulties in practice, when it is a matter of distinguishing them from malingering. The second group of reactive disorders, with more psychotic symptoms, comprizes: reactive depressions, stupor, and syndroms with delusions and hallucinations and paranoid states. In this category of disorders disturbances of consciousness are much more clearly discernible than they are in the first. Bunyeyev, however, correctly emphasizes the fact that clinical experience points to the fact that in the several syndroms distinguished above there are frequently contained elements, of other reactive syndroms, and, moreover, in a considerable number of cases it can be observed, how, in the course of the disorders, one set of syndroms gives way to other symptom syndroms. Consequently, the clinical picture is usually considerably more complicated than would result from a description that would only take into consideration the most fundamental elements. Among the three hundred and fifty cases of reactive disorders with prisoners under investigation the several syndroms make their appearance In the following dimensions:   Pseudodementia                                                 90 cases    25.7 per cent. Puerilism                                                              16     “          4.6 per cent.  Ganser’s syndrom                                              17     “          4.9 per cent. Depressions                                                         79      “        22.6 per cent. Syndrom of stupor (41)                                      59      “          and states of incomplete stupor (18)              47       “       16.9 per cent. Syndroms with hallucinations and delusions                      13.4 per cent. Paranoid states                                                    12       “        3.4 per cent. Conversion hysteria                                             20      “         5.7 per cent. Fancies with contents similar to delusions     10       “         2,8 per cent. Pseudodementia, Ganser’s syndrom and puerilism between them account for 35.2 per cent, of the material investigated. Pseudodementia and puerilism frequently constitute the source of serious difficulties when it is a matter of distinguishing them from malingering, if hospital observation is of too short duration. Seventy per cent, of the above cases spent over three months on observation in hospitals, including nearly twenty per cent, who spent more than six months there.  After a syndrom of pseudodementia, it may be sometimes observed the malingering of the extinct symptoms of that syndrom (metasimulation). Among the cases of metasimulation in the material under investigation in fifty-five per cent, malingering was precisely connected with pseudodementia. Reactive depressions are the second set, as far as numbers are concerned, in the material under investigation (22.64 per cent.). Reactive depressions are of various character. The obvious colouring of the majority of such states with hysterical traits frequently lends a peculiar stamp to the clinical picture, and may incorrectly suscitate a suspicion of malingering.  Mental disorders with a stupor syndrom, as is well known, rarely arise as isolated type of reaction. Considerably more frequently stupor takes place after pseudodementia, Ganser’s syndrom and puerilism, not infrequently after a period of a seeming withdrawal of all reactive symptoms. What is more, after stupor there frequently appear once more symptoms of other reactive disorders, first and foremost those of pseudodementia (Bunyeyev, Pastushenko). In cases of incompletely developed stupor there frequently appear suspicions of malingering, even though such casses ought to be numbered undoubted mental disorders.  When discussing cases with a hallucination and delusion syndrome one ought to remember that even in such cases the suspicion of malingering occasionally makes its appearance. This is influenced by the fact that the contents of the hallucination are closely connected with the prisonner’s own situation, that his behaviour is characterized by lively emotional reactions, and that he not infrequently manifests interest in his further lot, his family, etc. In fact the suspicion of malingering as a rule proves to be unfounded. Morever, it should not be forgotten that, in cases with a hallucination and delusion syndrome there not infrequently emerge serious diagnostic difficulties in connection with the posibility of the existence of schizophrenia.  Among the reactive disorders observed with prisoners in the hospitals there were twelve cases of acute paranoid state. In this, relatively very infrequent, syndrom, which develops against a background of intensified fear and anxiety, and rapidly disappears under conditions of hospitalization, the existence of hallucinations, mainly visual ones, has also been found.  The symptoms which approach delusions include the so-called confabulation, with contents resembling those of delusions (“wahnhafte Einbildungen” ), which had been described by Birnbaum more than fifty years ago. The inventing of occasionally the most improbable and queerest facts takes place against a background of usually glaringly expressed hysterical traits; occasionally elements of pseudodementia and puerilism become visible. All this together may suscitate serious suspicions of malingering; prolonged observation, however, makes it posible to find the existence of clearly reactive disorders. Of such cases there were ten in the material under investigation. Predominant among them were cases of persecutory pseudodelusions (eight cases), with the most absurd and fantastical subject-matter. In the remaining two cases it was grotesque grandiose pseudodelusions that made their appearance. Both the attitudes and the behaviour of all such individuals were, as a rule, in complete contradiction with the contents of their utterances. Those prisoners who exhibited symptoms of reactive mental disorders differ in an essential way from those prisoners who simulate pathological symptoms. First of all, there are considerably less recidivists among them: the percentage of the latter did not exceed 33 per cent, while with the simulators it reached 81 per cent. Among the prisoners with reactive disorders there are less individuals who would exhibit organic changes of the brain (23 per cent., as compared with 37,1 per cent, with the malingerers), while, on the other hand, the percentage of persons of the schizoid type is considerably larger (36 per cent., as against about 10 per cent, with the malingerers), as well as that of psychopaths with obvious hysterical traits (31.4 per cent., as against about 20 per cent, with the malingerers).  A mere 4.5 per cent, of the total number of prisoners with reactive mental disorders under investigation were found to be persons whose premorbid personality did not suggest any suspicions concerning pathology; all the remaining ones figure, in the diagnoses, either as psychopaths, or else as persons with symptoms of encephalopathy. In spite of the lack of any exhaustive anamneses in a great many cases it was found possible to state that at least 17 per cent, of the prisoners sent to mental hospitals because of reactive mental disorders had already previously suffered from such disorders. The cases of reactive states of a protracted character, numerous in the material under investigation (32 per cent, among the cases dealt with in the Institute of Psychoneurology) make one realize the importance of a proper conception of the problem of reactive mental disorders with prisoners. In those cases states which could at first produce an impression of simulation were relatively numerously represented. Mistrust in such cases might well be increased by the fact that nearly one-half of them consisted of prisoners accused of the perpetration of homicide. A hospital observation which went on for many months on end, not only did confirm the diagnosis of a reactive mental disorder, but has also, over and above that, demonstrated that those mental disorders had, in a considerable number of cases, become so deep, that a large number of the patients had to be assigned for release from prison. Merely about 22 per cent, of the total of those suffering from protracted disorders recovered their health and could, later on, be prosecuted before a law-court.  A working hypothesis in both prisons and forensic-psychiatric practice should therefore be the premisse that a pure malingering of mental disorders going on for a longer period of time is an altogether exceptional phenomenon, and that, as a rule, we have to do, in such cases, with reactive disorders. A different approach not only does run counter to the present-day state of psychiatrist knowledge, but is also highly harmful for both forensic and prison practice, as well as being inhumanitarian.   [1] In order to avoid any misunderstandings it ought to be emphasized that we are here referring to cases of long duration, of a malingering of mental disorders going on for at least several weeks on end. Clumsy attempts at simulating pathological symptoms for a period of a few days, naturally, altogether elude a psychiatrist who is not permanently employed in the prison in question, and, in all probability happen much more frequently

In the light of the surveys of the 15 - l7-year-olds “out of school and out of work,” it can be seen that a large majority of the subjects are recruited from among boys and girls whose basic problems can be reduced to school maladjustment, serious learning difficulties and inability to adapt to the school curriculum. With most of the subjects social maladjustment is clearly connected with school maladjustment, which is no doubt frequently the anterior process. The lack of detailed psychological and medical tests makes it impossible to say what are the factors chiefly responsible fur such school retardation: what percentage of the subjects are backward children, children with only partial developmental retardation, children with certain congenital defects which are serious obstacles to learning to read and write, or children with personality disorders which interfere considerable with a normal process of education, reduce their capacity for systematic effort, impede concentration, etc. The children whose normal progress at school encounters serious difficulties and cannot cope unaided with their school obligations have a sense of inferiority with regard to the other children in their class, and the conflict situations experienced by them continually and their fear of the consequences of bad results at school make for a hostile attitude to school, truancy, seeking contacts outside school with peers in a similar position, spending much of their time with other maladjusted boys in whose company they can win approval. Children of this kind frequently drop far behind in elementary school and sometimes fail to complete it altogether. Subsequently, they have a very difficult start in life, extremely limited prospects of employment in jobs with a low social status and a sense of personal failure and rejection which frequently helps to develop antisocial attitudes. In dealing with boys and girls of this sort who have already reached an older age bracket, one should realize that their considerable school retardation, their unaccustomedness for systematic study and the development of certain adverse habits militate against progress in the vocational schools to which they are directed. In view of the fact that teaching them a specific trade in combination with practical         in-work training may be of vital importance to their subsequent careers, the syllabus in these special vocational schools should be adjusted to the degree of inability displayed by such boys and girls. Since the boys who have not even completed six or seven grades of elementary school are in a worse position than those who have completed a greater number of grades, the syllabus of the vocational courses for these children should be differentiated to match their achievement level in elementary school. It seems essential therefore, before directing such boys and girls to a vocational school, to submit them to psychological tests to discover their intelligence level and suitability for a specific trade. The findings of these surveys make clear the importance from the point of view not only of the practice of the educational authorities but also of social policy of paying special attention to cases of recurring repetition of elementary school grades and truancy, and of failure to complete elementary school. Problems and failures at school require the early intervention of psychologists and doctors and the extension of special attention to such children in the earliest grades. The elimination and prevention of symptoms of school maladjustment depend on the proper organization of school work to allow for the specific problems of this category of children. It is essential to provide a sufficient number of special classes in the lower years to enable children making poor progress to catch up and also individual coaching of pupils who have special learning problems. The surveys show how important the implementation of the above recommendations could be for prevention of social maladjustment and demoralization among a large proportion of the children subsequently classified as “out of school and out of work”. The fact that among juvenile offenders there is a large incidence of records of serious disturbances in the course of their education from an early age is obvious evidence of the need to pay special attention to school maladjustment with a view to the prevention of juvenile delinquency. Since the surveys have shown that a large proportion of children with serious school failures come from adverse home backgrounds, from broken homes, from homes in which the father is an alcoholic and from homes whose material circumstances are bad, it is essential to put such families under special supervision and also to provide welfare benefits to the mothers of children in such home.

Publikacja posiada następującą strukturę: Wstęp I. Stanisław Szelhaus: Sprawcy przestępstw o charakterze chuligańskim II. Elżbieta Łojko: Sprawcy wykroczeń o zakłocenie spokoju publicznego w stanie nietrzeźwym III. Stanisław Batawia: Osoby niejednokrotnie przebywające w izbie wytrzeźwień IV. Stanisław Batawia: Wnioski wynikające z badań