Abstract
The paper describes Victor Kandinsky’s professional achievements within nineteenth-century Russian forensic psychiatry. A thorough review of nineteenth-century Russian psychiatry is presented, followed by a short biographical account of Kandinsky’s personal life. Within the backdrop of Russian forensic psychiatry toward the end of nineteenth century, Kandinsky’s pioneer innovations in psychopathology and classification as well as his contributions to Russian forensic psychiatry are reviewed. These are exemplified by two of his forensic case studies relating to forensic responsibility and malingering, which are included in his famous book ‘On Irresponsibility’.
Introduction and background
Psychiatric knowledge is accumulated by the great efforts of generations of physicians-alienists; some of their names are preserved as eponyms, for example, Kandinsky-Clerambault syndrome (Lerner, et al., 2001). Victor Khrisanfovich Kandinsky (1849–89) was one of the famous figures in Russian and international psychiatry (Lerner and Witztum, 2003, 2006). His name is connected not only with the clinical syndrome named after him, but also with his important contributions to the development of Russian forensic psychiatry. Many professional ideas, which today seem trivial and banal, were first introduced by Kandinsky towards the end of the nineteenth century, and were revolutionary at that time. For example, Kandinsky was a pioneer in developing the forensic concept of irresponsibility.
Before describing Kandinsky’s contributions to Russian forensic psychiatry, it is useful to include a short historical review of the state of psychiatry as a discipline in Russia before and during the nineteenth century. In Russia, the mentally ill were considered ‘God’s fools’, and they usually wandered about in the streets and in forests, although some of them were cared for by monasteries. In 1723 Tsar Peter the Great (1672–1725) prohibited sending the ‘madmen’ to monasteries, and tried to force city councils to build special houses for them. However, due to the nature of Russian bureaucracy, nothing was done. After Peter’s death, the mentally ill continued to be sent to monasteries (Kannabikh, 1928).
In I762 the Senate ordered that Prince Kozlovski, who was psychotic, ‘should not be sent to a monastery but rather placed in a special house which would be built for this purpose, as is the custom in foreign countries, where they have established “dollhouses” [madhouses]’. Nobody in Russia knew what a ‘dollhouse’ was, or how to build it in accordance with ‘the custom in foreign countries’ (Kannabikh, 1928). After a prolonged search, the Senate nominated the Academy of Sciences to fulfil this mission, and a historiographer named F. Muller provided the authorities with a brief description of what a ‘dollhouse’ should be. He clearly stated that treatment of the mentally ill should be left in the hands of a physician and, in his opinion, a priest should have nothing to do with insane people until they come to their senses and regain their reason. The origin of the term ‘dollhouse’ is not clear. It was used in the Russian psychiatric literature until the first part of the nineteenth century. It is possible that the term is a misnomer for the German word ‘Tollhaus’, which means a house for the insane (Zilboorg, 1943).
In 1775 Russia was divided into provinces – ‘gubernii’ (singular, ‘gubernia’), which became responsible for the organization and provision of general medical and psychiatric care for the population living in the provinces. After that, psychiatric wards were opened in general hospitals, and special hospitals were built for the mentally ill – ‘yellow homes’ as they used to be called (Kannabikh, 1928). The first psychiatric facility in Russia was opened in 1776 in the city of Novgorod. In the same year, a psychiatric ward for 26 patients was opened in Ekaterininsky Hospital in Moscow, and in 1779 a shelter for 32 mentally ill patients, later converted to a mental hospital, was opened in St Petersburg (Kannabikh, 1928).
Before the mid-nineteenth century, there were only a few physicians in Russia who considered themselves to be specialists in the care of the mentally disturbed (Brown, 1994). The view that mental disorders are real diseases seems to have been established there towards the beginning of the eighteenth century. In 1837 the first all-Russian registration of the mentally ill was carried out, and it showed that the prevalence of mental illness was 0.068 per cent. Towards the end of the nineteenth century, the number of patients increased 3.5-fold (Anikin and Shereshevskii, 1992).
In 1841 Dr Verchratsky proposed a descriptive classification of mental diseases that included such conditions as mania, mania with excitement, periodic mania with agitation, hypochondria, melancholy, epilepsy with mania, epilepsy with dementia, dementia, and amentia (Fedotov, 1983). In 1843 Dr Ieustin Diadkovsky (1784–1841) published a classification of mental disorders, including five levels of nervous and mental illness. He tried to connect disorders on the basis of mental functioning and not according to descriptive phenomenology. Thus, there were disorders of sensory functions and perception, disorders of cognition and volition, and disorders of motor and energetic functioning (Poemniy, 1959 ). Russian physicians began to show great interest in the aetiology, pathology and pathophysiology of mental illnesses, and the first generation of Russian psychiatrists was centred in the capital, St Petersburg.
The true development of Russian psychiatry started only in the latter half of the nineteenth century. The first representative of its academic psychiatry was Professor Ivan Mikhailovich Balinsky (1827–1902), also known as ‘the Father of Russian Psychiatry’ (Brown, 1994). In 1862 he organized the short-lived ‘Society of St. Petersburg Physicians for the Insane’, which reappeared in 1880 as ‘The Petersburg Society of Psychiatrists’. After returning from abroad in 1867, Balinsky instituted the teaching of psychiatry in the Military Medical Academy in St Petersburg as an obligatory course (Kannabikh, 1928).
The number of psychiatric hospitals increased rapidly. In 1810 there were only 14 hospitals, but after they were transferred to the responsibility of the Ministry of Internal Affairs in 1814, their number increased to 43 by 1863 (Kannabikh, 1928).
However, the development of psychiatry was slow. Thus, during the first all-Russian psychiatric congress held in Moscow in January 1887, only 86 of the 440 physicians who took part (about 20 per cent) had specialized in the study and treatment of mental diseases. Although there was great interest in psychiatry at the time, there were only a few psychiatrists due to the lack of well-organized institutions where clinical psychiatry could be learned and practised. Excluding those in St Petersburg and Moscow, there were only three additional psychiatric centres in Russia at that time: in Kazan, in Khar’kov and in Derpt (Dorpat in German, now Tartu, Estonia) (Kannabikh, 1928).
From the start, psychiatry in Russia was strongly influenced by German psychiatry because German professors, supported by the Russian Tsars, taught in the Russian universities, and many physicians continued postgraduate study in German clinics and universities after finishing their medical education (Zilboorg, 1943). The University of Derpt, being directly under the cultural influence of Germany – as was the entire Baltic region of Russia – was led by German professors. Russian psychiatry was also influenced by French psychiatry (Zilboorg, 1943).
In parallel with the establishment of general psychiatry, forensic psychiatry practice also developed, which brought some changes in the jury system started by Tsar Alexander II in 1864. The judicial system of the Russian Empire was based partly on the English model and partly on the French model. Certain principles were prominent: the separation of judicial from administrative functions, the independence of judges and courts, the public nature of trials and oral procedure, and the equality of all classes before the law. Moreover, a democratic element was introduced by the adoption of the jury system, and the election of judges (Kannabikh, 1928).
The 1864 reformation contributed to the advancement of forensic psychiatry. The courts began to invite psychiatrists as expert witnesses in questions of responsibility when the accused suffered from mental illness. Psychiatrists themselves began to place a higher emphasis on forensic psychiatry. They developed and studied forms and methods of psychiatric forensic examination, and established psychiatrists’ rights and fees as expert witnesses.
An important stage was the professional examination by the psychiatrist. The development of forensic psychiatry raised an urgent need for more accurate definitions and classifications of mental disorders. Forensic psychiatric practice prompted the elaboration of borderline psychiatric conditions, and their identification as separate clinical entities, such as psychopathy (Kannabikh, 1928).
It might be said that Russian psychiatry began in an era of bureaucratic inefficiency, political strife, cultural darkness and economic misery. However, over a short period of time Russian psychiatry overcame these obstacles and contributed to the world such important scientists as Merjeyevski, Kandinsky, Korsakov, Bechterev and Pavlov (Zilboorg, 1943).
In this paper we present information on Kandinsky as a pioneer in the development of forensic psychiatry in nineteenth-century Russia.
Short biography
Victor Khrisanfovich Kandinsky was born into a merchant family on 24 March 1849. During his childhood, he lived in a small Siberian village (Rokhlin, 1975). When he was 14 years old, he left Siberia to live in Moscow. He went to a well-known gymnasium and graduated cum laude, which allowed him to enter Moscow University Medical School without examinations. At the age of 23, he graduated from medical school and began to practise general medicine in one of Moscow’s hospitals. Early in his career he was interested in research, and between 1874 and 1876 he published 31 papers on different topics, including original contributions and literature reviews; three of these papers dealt with psychiatric subjects (Rokhlin, 1975).
From September 1876 to April 1879 Kandinsky served in the Russian Army as a physician. During his short military service, he took part in the war between Russia and Turkey (1877–8) as a ship’s physician, but he became ill. During the battle with the Turks, Kandinsky, suffering from hallucinations, jumped into the sea to commit suicide. Fortunately, he was saved, and in May 1877 he was sent to a psychiatric hospital where he stayed until April 1878. While in hospital he fell in love with his nurse, and after his discharge they were married. They spent the next six months abroad on leave. In October 1878 Kandinsky and his wife returned to Russia, but his mental state deteriorated and he was rehospitalized for a few months and then discharged from military service due to his psychiatric illness (Lerner and Witztum, 2003).
In 1881 the couple moved to St Petersburg, where Kandinsky (Fig. 1) began to work in a psychiatric hospital as a junior psychiatrist. He continued to work there for the next 8 years; in 1889 his mental state again deteriorated, he became depressed and committed suicide. Following his death, his wife collected his scientific writings and posthumously published his scientific papers and two books. After she had completed this, she also committed suicide (Panina and Rokhlin, 1975).
Victor Kandinsky, by an unknown artist, 1882 (from the collection of Professor Lerner’s father)
Kandinsky’s medical and scientific work can be divided into two periods: the first while he was living in Moscow (1872–6), where he worked as a general practitioner and his research included the philosophy and psychology of medicine. The second period includes his work in St Petersburg (1881–9), where his research was centred on psychopathology (e.g. hallucinations and pseudohallucinations) and forensic psychiatry. He made a significant contribution to clinical psychiatry with his book ‘About Pseudohallucinations’, which was highly regarded by the professional readers of his time (Berrios, 1998), and even today is considered to be one of the few monographs on this subject. Kandinsky’s important contribution to forensic psychiatry was his book ‘On Irresponsibility’ (1890).
The state of Russian forensic psychiatry towards the end of the nineteenth century
The implementation of law reform in Russia in 1864 caused heated arguments among psychiatrists, as well as between psychiatrists and lawyers, regarding the 36th section of the reform. This section was devoted to the problem of legal ‘irresponsibility’ in persons suffering from mental disturbances. Three professional meetings were held regarding this matter, but the psychiatrists involved could not resolve their disagreements. There were also two combined meetings including lawyers and psychiatrists. Most viewed the section as unsatisfactory. Lawyers wanted to insert a psychological criterion of mental disturbance but, according to the psychiatrists, there was no possibility of formulating one that would cover widely differing types of mental disturbances. A meeting on 12 Feb. 1883 led to agreement following Kandinsky’s speech, entitled ‘A special opinion’, in which he defended ‘a psychological criterion of irresponsibility’. He concluded by saying that section 36 loses its value if it includes only a short list of some reasons for irresponsibility; in his opinion, defining clear psychological criteria was a crucial part of section 36 (Kandinsky, 1890).
Calls for the broadening of the medical expert’s legal role took their most extreme form in the case of psychiatric expertise. By the end of the century, forensic psychiatrists were demanding judicial-institutional reform in the name of both social welfare and scientific interests. Prominent psychiatrists argued that the state’s judicial and penal institutions should be reorganized on the basis of a wider and more influential role for medical expertise in general, and in forensic psychiatry in particular. This expanded role, prophylactic in its ideal form, was to include a forensic-psychiatric examination of every criminal offender – the ‘criminal class’ – at each stage of judicial procedure and within penal institutions. However, with regard to the form of this institutional reorganization, Russian forensic psychiatrists – in sharp contrast to their European counterparts – rejected the idea of expertise that was either centralized or vested with autonomous authority. Instead, Russian physicians insisted that the expansion and development of forensic medical expertise should take place at the local level and in close conjunction with local, albeit transformed, judicial institutions.
Kandinsky’s pioneer innovations and his contributions to Russian forensic psychiatry
Kandinsky’s main professional contributions were in just a few areas: forensic psychiatry, psychopathology, and psychiatric classification.
In 1864 the legal system in Russia, which was based on courts of juries, began to invite psychiatrists as expert witnesses on questions of responsibility when the accused suffered from mental illness. The standard opinion at that time was that any patient suffering from any mental illness was not responsible for what he was doing. In his book ‘On Irresponsibility’ (Kandinsky, 1890), as well as in his papers and lectures, Kandinsky argued against this general and undifferentiated approach, suggesting that every case should be examined individually according to a specific diagnosis and the clinical state at the time the crime was committed. He also demonstrated that clinical states could be dynamic over time. For example, the condition of a patient who was found unable to stand trial could be improved, so he/she could later stand trial. Kandinsky also differentiated between the treating clinician and the forensic psychiatrist, believing that only the forensic psychiatrist should be permitted to give expert opinion to the court (Kandinsky, 1890).
It is important to note that at that time many psychiatrists, including prominent and well-known professors, could not understand why forensic psychiatry needed to be a separate discipline, and argued against it. But Kandinsky (1890) wrote:
‘the witness should deliver the plain facts; the witness from the medical profession should testify only on medical facts; the expert in the forensic area should extrapolate from the clinical materials and deduce from them conclusions that will help juries and the judge to arrive at the correct decision in the specific case.’
Many opinions concerning these subjects, that today appear trivial and banal, were first introduced by Kandinsky towards the end of nineteenth century and were revolutionary at that time.
Kandinsky’ book (1890) is composed of two parts. The first part includes the following themes: (a) a description of the theoretical basis underlying the responsibility paragraph of the criminal code; (b) Kandinsky’s different view, as stated at the psychiatric conference on 18 Feb. 1883; (c) Kandinsky’s proposed reformulation of the 36th section of the Russian criminal code. The second part of the book summarizes eight forensic psychiatric opinions given to the court regarding different psychiatric problems. These opinions were written by Kandinsky as an expert for the court.
The cases described were: (1) a psychopathic woman who was accused of murderous assault; (2) a person who suffered from organic brain disorder due to chronic alcoholism and who was also accused of murderous assault; (3) a person suffering from epilepsy, who was being prosecuted for seduction of a girl (six years old); (4) a man suffering from mood disorder (which today would probably be diagnosed as bipolar affective disorder), who was charged with embezzlement; (5) a woman with a personality problem (which today would probably be diagnosed as dependent personality disorder), who was accused of assisting her husband to commit suicide (she smuggled a gun to his cell); (6) a man with epilepsy and severe alcoholism, who was accused of murder; (7) a person with mental retardation, who was accused of murderous assault; (8) a person suspected of being a malingerer, who was prosecuted for murder. It is important to emphasize that all these subjects were admitted for observation at a mental hospital for long periods of time – from two to six months.
We have chosen to present the first case here because in it Kandinsky constructed and described at length (84 pages) his basic approach to the question of responsibility: that everyone who has a psychiatric problem is not necessarily released from criminal responsibility. This was a complicated case which resulted in strong disagreement among psychiatrists. The next six cases were relatively clear and simple, without differing opinions among the observing psychiatrists. We will also include the eighth example which described a complicated case of malingering.
Case no. 1: the case of the young woman Julia Gubareva
This case (Kandinsky, 1890: 43–126) describes a woman who was prosecuted for murderous assault. She was admitted for psychiatric observation on 8 May 1882.
Julia Gubareva was a 26-year-old single woman. Her father was not a heavy drinker, and got drunk easily. When Julia was 11, her father died from tuberculosis. Her mother was then 50 years old, a very sensitive but hot-tempered woman. She had given birth to 6 children, but 4 of them had died, and only Julia and her brother survived. During her first 8 years, Julia suffered from what she described as ‘pressure in my head’, accompanied by delusions and visual hallucinations. Her cognitive development was advanced. For example, when Julia was 6 years old, she learned to read in a week. From childhood until puberty she was very sensitive and had an extraordinary memory. Her character was described as stubborn, impulsive and very hot-tempered. From an early age, she showed a more masculine nature, e.g. she preferred to play boys’ games, fight with boys, and climb roofs and trees. At school she was a good pupil in subjects where she could use her excellent memory, but in mathematics she was below average. Her sexual affiliation was lesbian. She used to court young and beautiful women. At puberty her cognitive growth stopped, and her memory began to weaken. She could not finish secondary school and dropped out. At 16 years, Julia fell in love with a beautiful woman, explaining that she loved her ‘as a man loves a woman’. Only once did she have sex with a man, and from this event she became pregnant and gave birth to a child, whom she gave away for adoption.
According to her brother, from the age of 16 her character changed sharply. First, she became apathetic, but later she showed great stubbornness, self-sufficiency and extreme self-esteem. Her predominant mood from 18 to 22 was described as hypomanic.
Julia’s character was labile. For example, from timid, shy and restrained, she could instantly become wild and aggressive. Sometimes even a minor stimulus caused her rage. She used to drink alcoholic beverages, but she did not get drunk.
Usually she was a saver, but sometimes she surprised her mother by her wastefulness. Julia liked to dress herself in men’s clothing and even used to visit brothels where she danced and sang roughly as a man. Usually she did not care about her appearance and she detested female clothing. At the age of 22, she began to work as a carrier’s coachman. She liked horses and treated them well. She specially liked to harness and unharness them. Sometimes Julia dressed like a male coachman, and she was very happy when her close friends did not recognize her. According to her mother, on 1 June 1881 Julia began to beat her dog without reason. After her mother’s reproach she became furious, and then immediately calmed down when somebody walked into the room.
On the day of the crime, she visited an ill girlfriend and became very emotional since she was afraid that her girlfriend would die. In order to calm down, Julia drank about 150 ml of liqueur, which caused her ‘thoughts to become confused’ and she claimed that she did not clearly remember what she did. She went into the street and met a male acquaintance from whom she rented a coach. Julia said on the one hand that she did not know what happened, but on the other hand she added that ‘to recall it is very unpleasant’ for her. Julia said that her friend and the coachman began to argue and swear at each other. She got out of the coach and she did not remember how she got back in the coach. Her friend told her that he had severely beaten the coachman. Julia did not remember how she returned home. The next morning, she went to visit her sick girlfriend and her place of work. She discovered that her friend had stolen a horse. Her friend wanted her to get rid of the stolen horse and sell it. At the moment of the sale, she was reportedly cheerful. Julia said that after selling the horse, she went to a religious ceremony, and upon returning home she drank cognac and had a party for herself and her girlfriend. When she was asked to go to the police station, she became confused and ‘spoke too much’. She ‘told a pack of lies’ about her male friend, since it seemed to her at that time that he wanted to accuse her of committing the crimes.
In her psychiatric examination, she was described as a woman of average height, and well built. The physical examination was normal. She complained of headaches. She cried and laughed for no reason; her mood was very labile. She was cooperative and felt at ease. When confronted with unpleasant facts she turned red in the face, but without any embarrassment told about her love adventures and bragged about her conquest of women. During her hospitalization she fell in love with a beautiful female patient. She answered logically, but if she initiated the conversation, she jumped from one subject to another. Julia verbalized some odd and absurd ideas. For example, she was sure that when men and women use the same bath, pregnancy may ensue, and only after much persuasion did she agree to use the common bath. During her stay in the hospital, Julia twice became furious without any apparent reason, and after these episodes ended she could only partially remember the events. Her judgement was erratic and sometimes illogical or paradoxical. Her conception of illegality was simplistic and lacking a moral basis; she thought that stealing was a foolish act merely because there was a high probability of being caught. Her activities were affected by her temperament and impulses and not by commonsense. Quite frequently her motives were not clear even to herself, and her behaviour appeared to be impulsive. It is important to note that during her hospitalization, Julia did not demonstrate any symptom of malingering; on the contrary, she insisted that she was completely healthy.
According to Kandinsky, Julia Gubareva sometimes suffered from morbid states, although transitory, that could lead to a full mental disturbance. During these periods she had her ‘rages’, uncontrolled and false ideas, and depressive and manic states. Furthermore, her sexual orientation, ‘which was not acceptable in society’, influenced her mental state. In Kandinsky’s view, her condition should be diagnosed as psychopathy. On the one hand, Julia’s mental state did not fit any category which excludes responsibility; on the other hand, it was clear that occasionally she did not have free choice. According to the preliminary investigation, Julia Gubareva’s mental state at the time of the offence could not be clearly ascertained.
Since Kandinsky’s evaluation was conclusive, expressing no uncertainty, she was referred to other psychiatric experts for additional psychiatric forensic opinions, which were based upon outpatient examinations. These experts did not find any definite mental illness, although they agreed that she had a psychopathic character. After returning from the mental hospital to police custody, she attempted suicide by trying to jump down the stairs and by trying to hang herself.
Kandinsky continued to discuss the diagnosis of psychopathy and its nature: is this condition a clear form of mental disease or not? He wrote that Julia’s case presented a dilemma: on the one hand, there seemed to be several relevant psychiatric categories, while on the other hand it did not really fit any known psychiatric category.
It is important to note that in Russia at that time there was a psychiatric classification which included only nine categories. Kandinsky remarked that this classification was insufficient and suggested a new and more modern nosology including 16 categories. One of them – number 10 – was called ‘Psychohysteria’. This category was based on two ‘modern’ psychiatric textbooks: Lehrbuch der Psychiatrie auf klinischer Grundlage für praktische Ärzte und Studierende (1879) by the German psychiatrist Krafft-Ebing (1840–1902); and Les hystériques (1882) by the French psychiatrist Legrand du Saulle (1830–1886). The term ‘psychohysteria’ appeared in both of them. On the basis of these textbooks, Kandinsky suggested classifying three types of hysteria: (a) hysterical neurosis; (b) transient acute attacks of madness accompanied by manic state and transient attacks of delusions; and (c) persistent chronic hysterical madness.
Kandinsky concluded that Julia Gubareva was in a persistent psychopathic state and suffered a transitory attack of hysteric madness. He also thought that her hysterical condition was part of her progressive degenerate psychopathic state, from which she had suffered since her youth and that this was a morbid condition. However, Kandinsky emphasized that mental disorder is not the same as mental disease. From a forensic psychiatric viewpoint, the name of the mental state is not significant; on the contrary, in a few states, transitory attacks of hysteric insanity could be equivalent to madness, i.e. delirium (in its meaning of that period). Furthermore, Kandinsky quoted the definition of ‘madness’ (delirium) from the book by Johann Ludwig Casper (1796–1864) and Carl Liman (1818–91), Handbuch der Gerichtlichen Medicin (1876), the textbook of forensic medicine considered at the time to be the most authoritative. Their definition was: ‘delirium is a pathological acute mental disorder on the base of organic affection of nervous system’ (Casper and Liman, 1876: 318).
The psychiatrists’ expert opinions were divided. All of them agreed that Julia Gubareva suffered from psychopathy. At the same time there were not enough data to prove that at the time of the crime she was in a state of ‘madness’. However, there was also no evidence to show that she was in a normal state while committing the crime. After hearing the opposite opinions, the jurors concluded initially that Julia Gubareva was in a state of insanity at the moment of the crime. Later, after the judge demanded a clearer conclusion, they changed their evaluation of her mental state. However, in reference to the crime, they finally decided that there was enough proof that she had committed the crime, and Julia and her friend were released. The victim of the crime appealed to the Supreme Court which found her friend guilty, cancelled the previous decision, and reprimanded the regional court for its conclusion. With regard to Julia, the decision was that there was not enough proof that she had taken part in the crime. Therefore, she was released, while the friend was imprisoned.
Case no. 8: peasant F
This case (Kandinsky, 1890: 213–38) is the story of a peasant who was prosecuted for murdering his wife and who was admitted for psychiatric observation in 1888. Mr F was 30 years old, married, without children. The family history showed no mental problems, but his grandfather and his father suffered from alcoholism, and his father had delirium tremens.
F was physically healthy. He finished elementary school and knew how to read, write and count. When he was 18 years old, and at his father’s request, he began to work in the small family grocery. When he was 20, he got married, and the marriage was at first successful. Later, he began drinking excessively, especially vodka and rum, and his physical examination showed signs of chronic alcoholism (such as enlarged liver).
During the winter of 1886–7 he had a spell of lowered mood and he became preoccupied with suspicions about the infidelity of his wife. He consulted a famous priest who was known as an expert in helping alcoholics, and described his problems. The priest advised him to reduce drinking, advice which F followed, and from spring 1887 there were no alcoholic problems.
A day before he killed his wife, F was described by eye-witnesses as behaving normally. For example, he went to another village in order to buy a cow, made a good deal, and returned home with the former owner of the cow. The day after F paid him, they had two drinks together to celebrate the signing of the successful deal, but F did not get drunk. At noon he invited his wife to have sex. Shortly afterwards, F left his home, ran to his mother’s house and asked her urgently to come to his house to see what he had done. F’s mother arrived at his home and saw F’s wife dead of strangulation, her body still warm. There were no witnesses to the killing. He told the police that when they began having sex, his wife suddenly pushed him, jumped from the bed cursing and insulting him, and accused him of adultery with other women and with a mistress. She began to scratch him till he bled. He became furious and began to strangle her. Suddenly he noticed that the colour of her face had changed. He panicked and left her, going to the yard ‘running without purpose as a madman’, and then he went to call his mother. According to her testimony, the couple quarrelled a lot, and the wife used to curse and insult him. F himself claimed that his wife accused him of adultery and of having a mistress. From the winter of 1886, she became very nasty and offensive, and he stopped loving her. The relationship between them became so bad, that he prayed that ‘God would take her’.
F was admitted for the evaluation of his mental capacity to stand trial during June 1888. Kandinsky described his physical appearance and particularly mentioned the farmers’ alcohol abuse. On the first day of his hospitalization, F was calm, had no complaints, and described his previous life in detail. He communicated minimally with other examinees, had a good appetite and slept well. During the first half of July, he constantly complained of headaches. It was noted that before visiting the doctor, F rubbed his face and eyes with a blanket or a sleeve, and lay on the bed with his head dropped down, thus always appearing red-faced during his examinations.
During repeated psychiatric examinations, F claimed to be absolutely healthy, despite his headaches. However, sometimes a blackout would occur, and then he would ‘act completely crazy’. Moreover, the examinee emphasized that he suffered from blood rushing to his head. Objectively there were no symptoms seen. He talked actively with some of the staff who in turn noticed no mental disturbances. He spoke only with two of the other examinees. One of them was a person with whom F spent time in jail, and the other (according to Kandinsky’s opinion) was a malingerer. Kandinsky thought that this second person influenced F’s behaviour. From mid-July until 20 Aug., F began to complain about pain in different parts of his body, and that he slept no more than 3 hours a day. After night observation, F’s claims regarding his sleep proved false. Apart from sleeping 7–9 hours at night, he also would sleep 1–2 hours during daytime. Several times he was seen lying on the bed with his head down, in order to make his face red. Later, F began to stick his fingers into his ears claiming he was hearing noises. It turned out that he would only hear the noises when he put his fingers in his ears. After a suggestion not to continue this behaviour, the complaints stopped. At one time, replying to a question regarding his seeing things, he answered that he currently sees weird people. Kandinsky asked him to count them, and F started to count loudly ‘one … two … three …’, looking at people currently in the room. Then looking at Kandinsky he said ‘four’, and when the latter smiled the examinee added ‘five, I myself am the fifth’. Thus, there was no evidence of visual hallucinations.
From the evening of 20 Aug., F started to ‘rebel’, as he himself later described it. This ‘rebellion’ consisted of incoherent speech, marching from corner to corner, flapping his hands, and attempting to tear his clothes. This behaviour was not constant, lasting 1–2 hours in the morning and about the same time in the evening, with irregular intervals every 1–3 days. Sometimes these ‘attacks’ occurred only in the morning or only in the evening, but they only occurred when he thought that he was being watched by the staff, and not by the doctor. During this period, he usually slept 6–8 hours at night as well as in the morning and during the afternoon. While he was in psychomotor agitation, he was transferred to the department for acute psychotic patients, where he was physically restrained. At these times, no redness of the face was observed, which demonstrated that the redness was self-initiated. When he was calm, he was asked what had happened to him, and he would reply: ‘I don’t remember anything’, or ‘I had a crazy blackout and understand nothing’, or ‘I was day-dreaming and had different dreams’. When he was asked for more detailed answers, or was confronted, he would answer that ‘I have no way of knowing’. Once he said that he had a day-dream about Germany, but then again claimed that he had no way of knowing. During this period he was constantly placed with acute psychotic patients, and he carefully observed their behaviour. Now he began to ‘rebel’ when Kandinsky was present. He began to march about the room and sway from side to side, yet his speech was normal, and only while answering was he evasive and careful. When asked why he now spoke unusually in the presence of the doctor, he would reply that he ‘had run out of words …’, and ‘I talked a lot before, everyone around me heard me’. Sometimes he would ask if his behaviour was reported to the doctor when he had these episodes. Kandinsky replied that he himself would like to hear F’s speech disturbances, at which point F began walking slowly around the room, flapping his hands, and yelling, ‘Men, women, men, women …’. He repeated only these words. On 10 Sep., F was restrained due to ‘rebelling’. Kandinsky asked that the restraints be removed, and asked F to rebel orally, so that he could write it down. The subject replied, ‘Write down! So now I became restrained-unrestrained … for 14 kings … for 2 months … if I’ll like … I am prepared even for 10 years … Vasiliy Fiodorovich … Turkestan region … so now Vasiliy Fiodorovich is half a General and now he will be a full General … he is the first. The second is Vasiliy Frolov, the envoy of his majesty … 24 people … the eldest one is here … the third is Vasiliy Yakovlev, … the fourth is the youngest, Vasiliy Potapov … and then, I myself … in the name of the father, the son and the holy ghost (Then he cursed roughly but quietly and uncertainly. Then again, he quoted a prayer and cursed.)’. When the doctor noted that it is weird to combine curses and prayer, F replied that he also thought it was weird and then said, ‘I am tired and will say nothing more.’
During this conversation, F tried to talk to the doctor informally. However, when he noticed the doctor’s glance, he became confused and did not know what to do next. Kandinsky said to the assistant that if F was really mentally ill, he would not get confused. After these words, F got confused even more, turned towards the wall and began to cry. Kandinsky told him afterwards that by pretending he can only hurt himself, and F then said ‘How then can I help myself?’
After 10 Sep., F did not attempt to act as if mentally ill. He was quiet, answered questions logically, did not rub his face, and spent a lot of time lying in bed.
Kandinsky concluded that F was a malingerer, for the following reasons. Until he got acquainted with the hospital regimen and looked closely at mentally ill patients, F’s behaviour was normal. Furthermore, all oddities immediately disappeared after Kandinsky told him (purposely prematurely) that a forensic psychiatric opinion had been sent to the court. His sleep was normal, and he slept even by day. He deliberately rubbed his face in order to simulate a rush of blood to his head. His disruptive behaviour was only in the presence of personnel, and he was calm when he thought that nobody saw him. Moreover, his motor agitation was not aimless; on the contrary, it was purposeful and was not accompanied by disturbances in thought process. His disturbances in content of speech were not delusional. He tried to represent his intentional speech incoherence as delusions, but associative processes of thought were normal.
Kandinsky even discussed differential diagnoses between pathological and physiological affects: (a) during the height of rage, a person’s consciousness is so disturbed, that a person may have a blackout about this period; (b) reaction to the crime – the accused is absolutely indifferent to the crime perpetrated by himself and frequently falls asleep, and after awakening he remembers nothing; (c) a crime performed during a rage almost always differs from other kinds of crime by its excessive brutality, which could suggest that the crime was carried out in an abnormal mental state. Moreover, in order to diagnose a state of rage, it is necessary at least to establish a discrepancy between its cause and its consequences.
F did not complain about memory loss, nor did he have a blackout about the period of the crime. He was frightened by the ‘darkened’ face of his wife, and ran out to the yard. After that he went to his mother and told her what he had done.
Finally, Kandinsky (1890: 237) concluded that:
At present, F does not have any symptoms of mental disease.
Approximately a year before the crime, and due to excessive drinking, F had mental disturbances during a short period, but from January 1888 he was healthy.
At the moment of his wife murder, F’s mental state was normal and without any sign of rage. This was despite his mental disturbance during winter of 1886–7, due to an illness that can predispose one to rage attacks.
It is very difficult to differentiate between physiological and pathological affects; in this case one does not see rage, but a state of angry irritability that led to a murder after an unexpected offence immediately before coitus, when the person was predisposed to affect.
Kandinsky commented about F’s case that it was not ‘an intended murder’ but more like ‘manslaughter’.
Concluding remarks
Kandinsky’s main contribution to psychiatry was in examining and clarifying the concept of responsibility and lack of responsibility from the point of view of forensic psychiatry. His contributions as an expert in forensic psychiatry are expressed in his 1890 book entitled K Voprosu o Nevmenyaemosti [On Irresponsibility]. Theoretical innovations appeared in the detailed analyses and discussions of the forensic psychiatric conclusions. Kandinsky presented 8 cases (comprising 195 pages) which he described meticulously. He used the cases as vehicles to express his opinions concerning the question of responsibility. For example, in Case 1 he described in detail a term that was later called ‘psychopathy’. On the base of his clinical experience and the professional literature of international psychiatry, he presented his suggested classification, which was extensive and quite sophisticated for his time. All these psychiatric medico-legal reports reflect his understanding of general and particular patterns of mental disturbances. Kandinsky was one of the first Russian psychiatrists to use nosological principles in general, and forensic psychiatry.
Kandinsky’s short life was coloured and influenced by his own mental disease. However, his professional contributions to psychopathology in general, and to forensic psychiatry in particular, cannot be underestimated. His seminal book concerning the subject of irresponsibility, although published 120 years ago, was very influential in its time, and it still illustrates his important contributions to the fields of clinical and forensic psychiatry. As such, he surely deserves to be remembered as a pioneer of modern Russian forensic psychiatry (Pervomaiskii, 1991).