Jack the Ripper and the Case for Scotland Yard's Prime Suspect

by Robert House

  —R. D. Laing

  In the Victorian era, although detailed taxonomies of lunacy existed for upper- and middle-class patients, pauper lunatics were generally just lumped into one of three categories: those suffering from mania, melancholia, or dementia. Unfortunately, the use of these labels was inconsistent, and one modern study of British asylum entries between 1870 and 1875 found, “We could not discern exactly what differentiated the principal diagnoses, mania, dementia and melancholia.”1 “Dementia” was a blanket term that seems to have been applied to any patient with a cognitive deficit, including those suffering from brain damage or head trauma, and the insane. “Melancholia” was defined as depression characterized by underactivity, whereas “mania” was defined by overactivity. According to the study, “The term [dementia] applied to a huge variety of cases, including both patients with cognitive difficulties from any cause and psychotic patients who were not behaviourally overactive enough to be described as manic.”2

  In practice, it seems that if a patient was “overactive” or excitable, a diagnosis of mania would be applied, even if the patient had symptoms of insanity or schizophrenia. As noted in Dr. Henry Monro’s treatise, On the Nomenclature of the Various Forms of Insanity (1856), “Dementia should always be applied to a passive rather than an active state.”3 By the 1870s, however, the terms mania, melancholia, and dementia began to evolve and eventually acquired meanings at least somewhat analogous to the modern definitions of mania, depression, and schizophrenia, respectively. Still, the difference between mania and dementia was not very clearly defined, and even as late as 1899, Emil Kraeplin’s Lehrbuch der Psychiatrie (6th edition) noted that the primary differentiator between mania and dementia was that mania did not have a deteriorating course, whereas dementia was chronic and typically incurable. The fact that mania and dementia were not clearly differentiated or defined is not surprising, given the Victorians’ limited understanding of mental disorders. In some measure, this confusion persists even today—as a recent study noted, “The boundaries between schizophrenia and mood disorders are obscure.”4

  The ambiguous use of such labels in the Victorian era adds some confusion to our assessment of Aaron Kozminski’s mental condition, especially since in some cases patients were described with all three terms. Dr. Edmund Houchin, for example, described Kozminski as melancholic, but then on Kozminski’s Colney Hatch admission record, the “Form of Disorder” was given as “mania” with the symptom of “incoherence.” The diagnosis of mania probably means (at the very least) that Kozminski was excitable, overactive, and out of control when admitted. Such behavior would warrant a diagnosis of mania, and as such, it is relevant to remember that Donald Swanson claimed that Kozminski was brought to Mile End Workhouse “with his hands tied behind his back.” None of this changes the fact that Kozminski was almost certainly schizophrenic, as we shall see. Strictly speaking, however, the official diagnosis of his disorder, at least when he was first admitted to Colney Hatch in 1891, was “mania.”

  When Kozminski was transferred to Leavesden, his diagnosis was changed to “dementia.” This probably indicates that he had become more passive and manageable, perhaps as a result of sedation, and no longer required restraint. On the other hand, Kozminski may have been transferred to the custodial purgatory of Leavesden Asylum simply because the doctors determined that his mental disease was incurable and deteriorating.

  The term schizophrenia, meaning “splitting of the mind,” was coined in 1908 by Eugene Bleuler in reference to a mental disorder that had previously been referred to as dementia praecox, among other terms. The cause of the disease was then, and still remains, largely a mystery and the subject of much debate. Yet the weight of opinion now seems to support the theory that a person might be born with a predisposition for the disorder—either genetic or caused by complications in childbirth or brain damage—which is later “unmasked” by “stressors” in the form of difficult psychological, emotional, or social situations.5 As noted on the Web site for England’s National Schizophrenia Fellowship (Rethink.org), studies have shown that “possible causing factors include stress caused by institutional and individual racism, low employment levels, poor housing and lack of cultural identity.”

  People with schizophrenia typically begin to exhibit strange behavior many years before the disease actually manifests itself. In adolescence, they are often introverted and withdrawn, with few friends. As a study conducted at Emory University noted, “Subjects who go on to develop schizophrenia show a pattern of escalating adjustment problems. This gradual increase in problems includes feelings of depression, social withdrawal, irritability and noncompliance.”6 The onset of the disease is then preceded by a “prodromal phase,” during which a person will exhibit “escalating signs of behavioral dysfunction and subclinical psychotic symptoms.” This and other earlier pre-morbid symptoms are now considered stages in the evolution of schizophrenia. According to Kaplan and Sadock’s Synopsis of Psychiatry,

  Family and friends may eventually notice that the person has changed and is no longer functioning well in occupational, social, and personal activities. During this stage, a patient may begin to develop an interest in abstract ideas, philosophy, and the occult or religious questions. Additional prodromal signs and symptoms can include markedly peculiar behavior, abnormal affect, unusual or bizarre speech, bizarre ideas, and strange perceptual experiences.7

  The prodromal phase can last for a year or longer, after which time the onset of the mature form of the disease may either be sudden or gradually develop over time.

  Today, schizophrenia is typically diagnosed based on criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders (the DSM-IV), which identifies both positive symptoms (traits that are present in schizophrenics but lacking in normal people) and negative symptoms (traits that normal people have but schizophrenics lack). The primary positive symptoms of schizophrenia are bizarre delusional thinking, disorganized thoughts, and disorganized speech. A patient may speak in rambling sentences that seem to go nowhere, forming loose connections, getting sidetracked in midsentence, or jumbling words together incoherently in what is referred to as “word salad.” Delusions are often bizarre. A patient may have delusions of grandiosity or omniscience or may be convinced he or she has special powers. Frequently, people suffering from schizophrenia will be obsessed with terrifying invisible forces or some external threatening presence that is plotting against them. Another common positive symptom of schizophrenia is auditory hallucination, in which a patient will hear voices that “are often threatening, obscene, accusatory or insulting.” Negative symptoms can include a decline in motivation, movement, or speech. Some schizophrenics may experience an extreme fluctuation of emotional states, while others may have very limited and shallow emotional responses. It has also been shown that schizophrenics exhibit deficits in many aspects of cognitive functioning, including an impaired “ability to comprehend and solve social problems.”8

  One of the common subtypes of the disease is paranoid schizophrenia. In these cases, patients will commonly hear auditory hallucinations and be obsessed with paranoid delusions, typically of both grandeur and persecution. Yet disorganized thoughts, disorganized speech, and flat emotional responses are usually not as prominent in paranoid schizophrenics, and therefore people with this subtype of schizophrenia may be able to interact in society without immediately arousing suspicion that they are insane. Again, according to Sadock,

  Patients with paranoid schizophrenia are typically tense, suspicious, guarded, reserved, and sometimes hostile or aggressive, but they can occasionally conduct themselves adequately in social situations. Their intelligence in areas not invaded by their psychosis tends to remain intact. . . . Patients with the paranoid type of schizophrenia show less regression of their mental facilities, emotional responses, and behavior than do patients with other types of schizophrenia.9

  Other modern theorists propose that schizophrenia is not one disease but instea
d a cluster of symptoms along a spectrum. Such theories tend to find that there is less differentiation between some forms of schizophrenia and bipolar disorder, because both share many symptoms. Some propose, for example, that paranoia is a separate disorder or “dimension,” and that it should be considered at the milder end of the spectrum of schizotypal symptoms than those symptoms typically associated with more severe “disorganized” schizophrenia. It even seems possible that the course of the disease might progress from milder symptoms (paranoia and “mania”) to more severe ones (disorganization and depression or catatonia). As such, it is important to point out that violent behavior is often associated with paranoid delusional thinking.

  It seems clear that Kozminski was suffering from some form of schizophrenia. His belief that he was “ill, and his cure consists in refusing food,” and his belief that he was “under protection of [the] Russian Consulate” are classic examples of delusional schizophrenic thinking. He also claimed that “he knows the movements of all mankind” and noted the presence of what he called an “instinct,” which, as written on the Colney Hatch record, was “probably aural hallucination.”10 For the three years that Kozminski was at Colney Hatch, he was dominated by this instinct. For example, on February 10, 1891, he was described as being “difficult to deal with on account of the Dominant Character of his delusions. Refused to be bathed the other day as his ‘Instincts’ forbade him.”11 Another entry, on April 21, 1891, noted, “still the same ‘instinctive’ objection to weekly bath.” Kozminski’s instinct was probably what would now be called a “command-type hallucination,” a voice that told him what to do and that commented on his actions. Kozminski was still experiencing these hallucinations years later, as seen in an entry in his case file at Leavesden Asylum on February 2, 1916, that recorded, “He has hallucinations of sight and hearing and is at times very obstinate.”12

  The fact that Kozminski’s instinct told him not to accept food from other people suggests that he believed his food was poisoned, and this, along with his grandiose delusions of omniscience, may indicate that he was a schizophrenic of the paranoid subtype. This is relevant to our assessment of Kozminski as a suspect in the Ripper case, because, as mentioned earlier, paranoid schizophrenics can appear outwardly more normal than disorganized schizophrenics do. According to Lauren Post, a licensed independent clinical social worker (LICSW) at the Boston Institute for Psychotherapy, “paranoid types tend to be more suspicious of other people and therefore are more guarded themselves, making them appear more distant. In that way, the less they reveal, the more likely they are to appear ‘normal.’ ”13 Still, as Post conceded, it would be impossible to give an accurate diagnosis based solely on Kozminski’s surviving asylum documentation.

  In any case, a purely clinical assessment of Kozminski’s condition gives us no idea of what schizophrenia is actually like for the person who experiences it. For a more in-depth perspective, I turned to Elyn Saks’s autobiography, The Center Cannot Hold: My Journey through Madness. Saks’s story is an insightful and fascinating first-person account of her experience as a schizophrenic and of the ways the disorder was outwardly manifested and perceived by the people she interacted with. The book describes schizophrenia as a terrifying experience that Saks referred to as “disorganization,” in which her brain essentially ceased to be able to organize thoughts coherently. “Consciousness gradually loses its coherence,” she explained. “No core holds things together, providing the lens through which to see the world, to make judgements and comprehend risk.” Her thought processes began to revolve increasingly around fantasies and delusions that were “extremely vivid and for me, not entirely distinguishable from reality.”14

  Saks was a highly intelligent woman who was admitted to a prestigious program in philosophy at Oxford University. Shortly after beginning her studies, however, she had a disastrous manic episode and quickly unraveled, to the extent that her doctors recorded that she seemed “physically and mentally retarded.” According to Saks, this was because she had become unable to articulate the thoughts that were in her head. As she said, “I was finding it difficult to speak. Literally the words in my head would not come out of my mouth. . . . I’d start a sentence then be unable to remember where I was going with it. I began to stammer severely . . . disengaged from my surroundings, I sat in the dayroom for hours at a time, jiggling my legs, not noticing who came in or out, not speaking at all.” She also began to hear voices. “In my fog of isolation and silence I began to feel I was receiving commands to do things. . . . The origin of the commands was unclear. In my mind, they were issued by some sort of powerful beings. Not real people with names and faces, but shapeless powerful beings that controlled me with thoughts.”15

  Saks was paranoid and thought people were trying to hurt her, but interestingly, this fear manifested itself in the delusion that she was in complete control of everything. “I am in control,” she said. “I control the world. The world is at my whim. I control the world and everything in it.”16 She vacillated between these two seemingly opposite states: on the one hand, utterly dominated by outside forces, and on the other, being the controller—at times she was the victim, and at other times the victimizer. Yet occasionally, even while in a manic state, she was able to interact with people and could hide her delusional thinking from others by projecting a “normal” persona. As she wrote,

  Psychosis is like an insidious infection that nevertheless leaves some of your faculties intact. . . . Completely delusional, I still understood essential aspects of how the world worked. For example, I was getting my schoolwork done, and I vaguely understood the rule that in a social setting, even with the people I most trusted, I could not ramble on about my psychotic thoughts. To talk about killing children, or burning whole worlds, or being able to destroy cities with my mind was not part of polite conversation.17

  Saks’s insanity was degenerative and came in cycles. This is typical of the course of schizophrenia, which is characterized by “exacerbations and remissions.” Acute psychotic episodes may come and go periodically for many years, and during remission the patient may function normally for long periods. According to the National Schizophrenia Fellowship, “Most people will be able to function normally for long periods at a time. . . . Approximately two-thirds of those who develop the condition experience fluctuating symptoms over many years.”18 Recovery is now typically achieved through the use of antipsychotic medications. Saks went through long periods where her psychosis was in recession, even without the use of antipsychotic drugs. Yet then she went through degenerative cycles, during which she became nearly catatonic, and even though she was high functioning and very intelligent, she was perceived as being “mentally retarded.”

  A realistic understanding of schizophrenia is crucial to our assessment of Kozminski as a suspect in the Whitechapel murders, especially since the symptoms noted in his asylum records are so often used as the basis of an argument that he could not have been Jack the Ripper. For this reason, Saks’s account is very important, because in many ways it mirrors what we know about Kozminski’s insanity. Like Saks, Kozminski had delusions that he was guided and controlled by “an instinct that informs his mind” and also had delusions of control, claiming that “he knows the movements of all mankind.”19 His psychosis was also apparently episodic, because he went through periods of “chronic mania,” excitation, and incoherence and other periods when he was quiet, well behaved, and responsive to questioning.

  Today, antipsychotic medication and psychotherapy are fairly effective in combating the symptoms of schizophrenia and halting the progress of the disease. But when Kozminski was in the asylum, there was basically no treatment for the disease at all, discounting sedation. When untreated, schizophrenia’s course can be devastating. Kaplan and Sadock’s Synopsis of Psychiatry notes that “deterioration in the patient’s baseline functioning follows each relapse of the psychosis.”20 Patients would often eventually degenerate to the point where they became reduced to what is kn
own as a catatonic stupor. This apparently happened with Kozminski, whose later case notes at Leavesden Asylum indicate that he had deteriorated to the point that he was mumbling to himself, largely mute and unresponsive to questioning. By 1910 (after sixteen years in the asylums), Kozminski was unable to answer simple questions and was, like Saks, described as “dull and stupid in manner and faulty in his habits.”21

  Because of the degenerative nature of schizophrenia, we must not make assumptions about Kozminski’s mental state in 1888. In all likelihood, he got worse gradually, over a period of years. He may have started having delusional thoughts as early as 1885, followed by periods during which he was able to function normally. We do know that by the time he was brought to the workhouse in 1890, his family was aware that there was something wrong with him. Yet prior to this, the extent of his mental disease is not known, and it may have been less severe. Like Saks, Kozminski may have been able to hide the outward symptoms of his disorder, making him seem at least superficially normal. In 1888, the year of the murders, Kozminski may have still been able to speak with people without immediately arousing their suspicions, while at the same time, in his mind, he was highly delusional, living in a fantasy world and receiving auditory hallucinations and instructions from his “instinct.”

  The link between schizophrenia and violent behavior is a highly debated topic. Although past research suggested that there was no causal link between schizophrenia and violence, recent studies have shown that this may not be the case. “Most studies confirm the association between violence and schizophrenia,” a 2002 study noted. “Recent good evidence supports a small but independent association. Comorbid substance abuse considerably increases this risk.”22 Another study cited data showing that “5 percent to 10 percent of those charged with murder in Western countries have a schizophrenia spectrum disorder.”23 Both studies concluded that alcohol abuse dramatically increased the likelihood of violence in schizophrenics. The largest study yet of the link between schizophrenia and violence found that 8.2 percent of the schizophrenic study group had been convicted of a violent offense—a rate 4.5 times the 1.8 percent of those without mental illness.