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NovemberTHEAMERICANJOURNALOFPSYCHIATRY1962REACTIONTOEXTREMESTRESS:IMPENDINGDEATHBYEXECUTION’
HARVEY
BLUESTONE,M.D.,
D
CARLL.McGAHEE,M.D.2Weconventionallythinkofdeathas“theworstthing”thatcanhappentous.Know-ing,aswealldo,thatwewilldieinsomevaguefuturedoesnotimposeanygreatstress.Themaninthegripofarelentlesslyfataldiseasehastocopewithmuchmoresevexestress.Butmercifully,hisdeathdateisnotfixedandhecanalwayshopetoseetomorrow’ssunrise.Presumably,thegreat-estofstresseswouldbeimposedonthemanwhoknowsheisgoingtobeputtodeath-andknowsjustwhenthatwillbe.Wehavestudied18menandonewomanintheSingSingdeathhouse.Becauseoftheinmateutilizingopportunitiesforap-pealsforclemencyorcommutationthereisadequatetimeforrepeatedpsychiatricin-terviewsandpsychologicexaminations.Thesemenarehousedinanareade-tachedfromtherestoftheprison.Theyhavefewvisitors,thoughtheauthoritiesimposenorestrictionsonvisiting.Onemightexpectthemtoshowseveredepres-sionanddevastatinganxiety,yetneithersymptomwasconspicuousamongthese19doomedpersons.Bywhatmechanismsdidtheyavoidtheseexpectedreactionstosuchoverwhelmingstress?Dotheiremotionalpatternschangeduringayearortwoinadeathcell
?
And,dothesedefensesfunctiontothemomentofexecution-ordotheycrumbletowardstheend?The19historieshadcertainfeaturesincommon.Allhadcomefromdeprivedback-grounds.Allbutonecamefromhomeswherethefatherwasmissing(deserted,dead,unknown,orseparated)duringthechildhoodoradolescence.Practicallyallhadbeenbroughtup(duringtheirgrowingyears)ininstitutionsorfosterhomes.Notonehadaneducationbetterthanthatoftenthgrade.Somewereilliterate.TheirintelligencevariedfromanIQof60toone
‘Read
at
the118th
annual
meetingofThe
American
PsychiatricAssociation,Toronto,Canada,May7-11,1962.
2
York.withanIQof140.Allhadbeenconvictedofmurder.Noneofthemurderswaslongplanned:theywereimpulsive.Manywerecommittedinconnectionwithafelony.Theworldappearedasahostile,dangerous,andmenacingplace,andtheyhadreactedintheirway-byaggression,suspiciousnessandcynicism.Thefollowingarebriefsummariesofthereactionofsomeofthesementotheirim-prisonmentinthedeathhouse.(Forcol-lectivedatav.Table1.)1.Thismanhasthelongestresidenceinthedeathhouseofthosein
thisstudy,
ap-proximately2years.Anovertconfirmedhomo-sexual,he
maintainedacalm
convictionthathewouldbeultimatelypardoned.Thisbeliefremainedbolsteredthroughoutbyanunchang-ingcontentionthathehadbeenframedbythelegalandmedicalauthoritiesinvolvedinhisprosecution.Psychologicaltestingshowedamanofaverageintelligencewithconsiderablewithdrawalfromrealemotionalinteractionwithothers.Defensemechanismsofdenialandprojectionwereeffectivein
warding
offanxietyanddepressiondespiteprolongedin-carcerationinthedeathhouse.2.Thisinmateistheonlywomaninthisseries.Sheisofdullintelligence,actsinaplayfulandflirtatiousmanner.Shewasusuallyeuphoric,butbecametransientlydepressedwhenshethoughthercasewasgoingbadly.Shefrequentlycomplainedofinsomniaandrestlessness.Thesesymptomsquicklydisap-pearedwhenshewasvisitedbyapsychiatristwhomsheenjoyedseeingandtalkingtoinaself-justifyingandself-pityingmanner.Psycho-logicaltestsshowedpervasivefeelingsofin-security,repressivedefenses,andan
inability
tohandleangryandaggressivefeelingsinaneffectualmanner.3.Thisinmateisa
withdrawn,
sullen,un-communicativeindividual.Whenvisitedinthedeathhousehewouldelaboratelyandslowlywashhisclothesignoringexaminers.Hespendsmuchofhistimereadingprofoundphilosophi-calworkswhicharebeyondhiscomprehension.Hisintelligenceisdull-normal.Hehasbecome
IIIII11101111111111111111IUll1111111
YF5N-CX3-H48A
394
REACTIONTOEXTREMESTRESS
[November
TABLE11.
Agerangeofdeathhouseprisoners18oryounger119or20221through25526through30330to355over353
2.FamilybackgroundParentstogetherduringmostofchildhood1Fatherunknownordeserted7
Fatherdivorcedorseparated
10Fatherandmotherunknown1
3.
HighestschoolgradereachedFourthorlower4Fifthorsixth8Seventhoreighth2Ninthortenth54.IntelligenceQuotient60through69270through795
-
80through89790through1194120through14015.FamilystatusofprisonerasadultNevermarried,buthadcommon-lawspouse5Nevermarried,noregularconsortium11Marriedbutseparated2Uvingwithwife16.Psychologicaldefensemechanismsused(Totalsmorethan19;someusedmorethanone)Denialbyisolationofaffect7Denialbyminimizingthepredicament4Denialbydelusionformation1Denialbylivingonlyinthepresent4Projection7Obsessiveruminationinconnectionwithappeals3Obsessivepreoccupationwithreligion2Obsessivepreoccupationwithintellectualorphilosophicalmatters5
progressivelymoresuspiciousandgrandioseduringhisdeathhousestay.4.Thismangivesalonghistoryofde-linquentbehavior.Heisalitigiouslyminded
individual
whostatesthathecanappealhiscaseforyears.Heisobsessedwithhisownpowerandisconvincedthatalawsuitagainstthedistrictattorneyforlostautomobiletoolskeptthatofficialfrombeingreelected.Hehasbecomeprogressivelymoreangryandabusiveultimatelynecessitatinghisphysicalisolationfromotherinmates.HisIQis134.Projectivetestsshowachronicallycold,
withdrawn,
nar-cissisticallyinvestedpersonality.Withdrawal,projectionanddenialareprominentdefensemechanisms.
5.
Thismanisatalltimeseuphoric.Hehasshownlittleanxietyduringthefullyearhehasspentinthedeathhouse.Hehasledahedonisticlifeandhasneverbeenabletomakefutureplans.Hisinabilitytoseebeyondthedayseemsquiteeffectiveinenablinghimtoavoidanxietyanddepression.6.Thisinmateshowedduringhisearlymonthsofincarcerationacontemptuousin-differencetowardtheauthoritiesandhisownplight.Gradually,however,depressionap-pearedandbecameprogressivelymoreintense.Thiswasratherdramaticallyreversedwhentheinmatepresentedanapparentreligiousconversion,whichseemedtobothoccupyhismindandalsoelevatehimabovetheauthori-tiesandhissituation.However,thisdefensewasonlypartiallysuccessfulforthisindividualwhohadalife-longhistoryofdischargingalltensionsbyimmediateimpulsiveacting-out.Psychologicaltestingshoweddull-normalin-telligenceandaprimitive,self-absorbed,hos-tility-riddenpersonality.8.Thisinmaterelatedtoexaminersinanopenanddirectmanner.Heismentallydullandpreoccupiedwiththoughtsofvoodoospells.Hisprimarydefensemechanismisdenialofthepossibilityofbeingexecuted.Thisworkspoorlyandheischronicallyanxiousandperiodicallydepressed.Hisangerathisaccomplice,whoheisconvincedisthecauseofhisdifficulties,seemstorelievehimofsomeofhisunpleasantfeelings.Heamuseshim-selfinworkingonatauntingpoemwhichheproposestorecitewhenhisaccompliceisexecuted.Thismechanism,too,isineffectualandherevertsfromthesethoughtsofrevengetoacontemplationofhisownplight.9.ThismanisamoodyindividualwhofeelsheisthevictimofaJewishplotsincethejudge,districtattorney,andhisowncourtappointedlawyerareJewish.Hedeniedhisguiltrepeatedlyduringhisearlydays
in
thedeathhouse,butbecameprogressivelymoreconfusedandafewdaysbeforehisscheduledexecutionaskedtheexaminerfortruthserumsothathewouldknowwhetherornothecommittedthecrime.Heshowedalternatinguseofintrojectionandprojection.Hewouldbecomedepressedwhennewsofhisappealwasbad,andwhenastayofexecutionwasgrantedhebecameparanoidandgrandiose.HemanagedinsomeobscurewaytoidentifyhisimpendingdeathwiththatofLumumba,whohadrecentlybeenkilledintheCongo,andfeltthathisownexecutionwouldmakehimamartyrinthecauseofanti-imperialism.10.Thismanstandsoutintheseriesasbeingtheonewhomostsuccessfullyemployed
1962
1
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:‘s
r
HARVEYBLUESTONE,ANDCARLL.MCGAHEE
395
intellectualizationasameansofdefendingagainstanxietyanddepression.Heelaboratedaphilosophyoflifeandvaluesinwhichhisowncriminalcareerbecamenotonlyjusti-fiable,butevenrespectable.Herationalizedhiscrimesbyemphasizingthehypocrisyandperfidyofsocietyontheonehandandbycomparinghimselfwithpolicemenandsoldiersandotherswholivehonorably“bythegun”ontheother.Thissystemwassoeffectiveforhimthatevenwhenexecutionappearedimminenthemaintainedhishero’smartyrroleanddis-dainedtorequestexecutiveclemency.11.Thisinmateisanilliterate,inadequateindividualwhowasconvictedasanaccomplicetoarobbery-murder.HehadanoverallIQof
51.
Heshowedprimarilydepression,with-drawal,andobsessiveruminationoverthede-tailsofhiscrimeandconviction.Heeventuallyevolvedapoorlyelaboratedparanoidsystemwherebyhesupposedlywasbetrayedandframedbyhisgirlfriendandoneoftheco-defendants.Despitetheloosenessofhisperse-cutorythinking,
it
wasaccompaniedbyaclear-cutelevationinhismoodandreductionofanxiety.12.Thisinmate,alsoanaccomplicetoarobbery-murder,showedoneofthemostfloridpicturesofanyinthisseries.Bothgrandioseandpersecutorythemeswereprominent,butthelatterpredominated.Hemaintainedthat
his
arrestandconvictionweremaliciousfrauds,andhemeticulouslyandobsessivelycombedthroughthecourtrecordtosubstantiatehiscontentions.Hisargumentswerelaboredandillogical,hingingonsuchpointsastheuseofwordslike“who”and“whom.”Theparanoidmechanismsseemedtomitigate,butnotcom-pletelydefendhimagainstdepression.13.Heisoneofthetwoinmatesinthisserieswhousesreligiouspreoccupationashismajordefensemechanism.Herepeatedlyinanalmostwordforwordwaystatedhissitu-ationasfollows.“NoonecanunderstandhowIfeelunless
it
happenedtoyou.ChristcametomeandIknowHediedformysins.Itdoesn’tmatterifIamelectrocutedornot.IamgoingtoanotherworldafterthisandIampreparedfor
it.”
Ashisstayprogresseshebecomesincreasinglymorehostileandantago-nistic,andhisbehaviorprogressivelyoutofkeepingwithhisprofessedreligiousideas.Inadditiontoobsessiverumination,projectionandwithdrawalareemployedtowardofffeelingsofanxietyanddepression.
DISCUSSION
Facedwith
certain
andignominousdeath,apersonwouldpresumablybeover-whelmedwithanxietyorplungeintothedepthsofdepression.Yetthisdoesnothappen.Whatdefensedoesthehumanmindsetupagainstintenseanxietyoraparalyzingdepression?Wesuggest,onthebasisofour19casestudies,thatthede-fensesareofmainlythreetypes-denial,projectionandobsessiverumination.Thecommonestformof
denial
isisolationofaffect.“So,they’llkillme;andthat’sthat”-thissaidwithashrugoftheshoulderssuggeststhattheaffectappropriatetothethoughthassomehowbeenisolated.Asec-ondcommonformofdenialistominimizethegravity
ofthepresentsituationandtotakeforgrantedthatanappealwillbesuccessful.The
third
andmostextrememanifestationofdenial,usedbyonlyoneindividual,wastodelusionallybelieve
that
apardonhadbeengranted.
Denial
is
also
commonlyusedbypersonsdyingofdisease.Thereisanotherphenomenonwhichde-servesfurtherexplanation,sinceitmayeasi-lybeconfusedwithdenial.Severalcasesim-pressedtheexaminersasbeingsoimmersedinthepresentmomentasto
virtually
beinsulatedfromanysignificantemotionalrelatednesswiththeir
own
pastorfuture.Thus,theydonothavetodenyanxietysincetheydonotexperience
it.
This,in-cidently,isthetraditionalprofileofthe“psychopath”whoreactsonlytopresent
stimuli.
Projection
is
anobvious,andnot
uncom-mon,mechanism.Typically,ittakestheformofpersecutorydelusions.Atleastthree
of
our
prisonersconsideredthemselvesper-secutedbyspecificgroupsinthecommu-nity.Thismechanismconvertsdissolutecriminalsintomartyrs.Itisacomfortingdelusion.While
it
doesnotdenythatdeath
isjust
aroundthecorner,
ittriestolenditdignityandmeaning.
Insomementhere
seemsto
beanalmostquantitativerecipro-calrelationshipbetweentheuseofprojec-tionandintrojectionsothattheyare
either
overlyparanoidordepressed.Athirdwayofcoping
with
painfulaffectsisto
thinkfuriously
aboutsomethingelse.Thus,thedepressingthoughtiselbowedoutofconsciousnessbythecrowdofotherideas.Weseethisinamorbidobsessionalconcernaboutthepreparingof
appeals
orpleasforclemency.Oneprisonerspoketo
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