IMBECILLITÀ, IMBECILLI. — Imbeciles, or “biopathic frenast(h)enics (v.)”, are individuals in whom mental insufficiency, more or less severe but always less pronounced than that of idiots (v.), is due particularly to inherited neuropathic taints, although those toxic or infectious factors of such importance in the genesis of idiocy are not excluded, albeit in a less severe degree.
Organically, imbeciles do not present the serious anomalies and malformations characteristic of idiots, nor the neurological symptomatology of the motor sphere so manifest in idiocy; they often do, however, display defective and insufficient bodily development, a small cranium (submicrocephaly), dysmorphias of the head, face, teeth, ears, etc.—morphological atypias revealing the family’s degenerative tendency. Some (S. De Sanctis) describe intermediate forms that cannot easily be classified in one group or the other (“imbecile-idiots” or “biocerebropathic frenast(h)enics”).
The intellectual development of imbeciles is greater than that of idiots, but does not approximately exceed that of a child approaching puberty. The deficiency appears in the torpidity of perception, despite the activity of the sense organs, and in the lability of attention; the higher powers of the mind are particularly impoverished, as manifested by the inability to form abstract concepts, to establish new connections among them, and to assess their value in reasoning. In some imbeciles, there is a strikingly unilateral development, of a mechanical type and at times to a very high degree, of certain faculties (musical ear, exuberant loquacity, memory for dates and numbers, extreme facility in mental calculation, etc.); these elements, however, are not organically employed in reasonable mental constructions.
As regards disposition, imbeciles appear either in the torpid or the excited type. The former maintain toward their surroundings a detached and apathetic demeanor, with a tendency toward reflex automatism; the expression of the face is inexpressive, the gestures slow and heavy, and the subject remains docile without taking any initiative. Excited imbeciles appear restless, aggressive, inconstant, and capricious in their will, displaying an often continuous and tireless external activity which, however, through the discontinuity and lack of coordination of its object, betrays the illogicality and incoherence of the motives animating II. They are therefore also called unstable, particularly when, the aggressive character receding into the background, dispersion in psychic activity and dissipation in practical conduct prevail. Because their ideas incline toward tumult and logical incoherence, excited imbeciles tend toward fancifulness, mental constructions, and speech in which mnemonic activity is distorted by fantasy, the imprint of objectivity is entirely absent, and judgment is deficient. Hence their tendency to distort facts and to be very often liars—not in the sense of deliberately intended falsehood designed to deceive or obtain some advantage, but because of the disorder of their imagination and the lack of fidelity and tenacity in their memory. Thus, as occurs in other psychic and psychoneurotic anomalies, they may produce connected and plausible testimonies and narratives entirely lacking correspondence with reality (“fantastic pseudology,” “mythomania”).
The moral consciousness of imbeciles is at the same level as their intellectual consciousness, and is very often anomalous and perverted through the complete absence of the higher sentiments; consequently, the majority of such subjects must be regarded as amoral and antisocial. Sexually, the serious or complete deficiency of modesty is often manifested in brazen forms of abuse and perversion. In a specific category of these afflicted persons, the absence of moral sentiments comes so much to the fore that it gives the individual the character of the so-called “moral imbecile” or “moral madman,” while some even speak of “constitutional immorality,” characterized by absolute insensitivity to higher motives in regulating actions, intolerance of restraint and social ties, inability to be educated, affective obtuseness, insensitivity to the suffering of others, a tendency to associate with or allow themselves to be dominated (succubus) by others in criminal activities, and to slide into sexual aberrations and crimes. The so-called “positive criminal school,” under the auspices of C. Lombroso and E. Ferri, sought to create the type of the “born criminal,” also characterized by particular somatic anomalies which, according to the proponents of this anthropological type, would have possessed the value of ancestral degenerative traits, marking arrests or reversions in the normal phylogenetic evolution of the human race. Because of the characteristic ineducability and constitutional irresponsibility attributed to him, such an individual would have benefited from absolute non-imputability.
At present, the classical Lombrosian concept has lost the value it held for the materialistic conception of the human person proper to the period in which it arose. On the one hand, a criminal constitution in the strict anthropological sense of the word is no longer admitted; alongside the subject’s neuropsychological characteristics, great importance is assigned to education and environment as factors determining crime. On the other hand, statistical inquiry shows that the great majority of inmates in penal institutions consists of ordinary individuals, not somatically predestined to delinquency (v. ANTROPOLOGIA CRIMINALE; DELINQUENTE). Clearly, this does not mean that the possibility of the criminal madman is to be excluded.
The educability of imbeciles cannot be determined in absolute terms, since it is dependent upon the subject’s degree of mental development. Within the family, it most often amounts to an undertaking of social isolation, which may be useful from a prophylactic standpoint, especially in cases where the clinical particularity of the disease makes the individual dangerous to society. Apart from prudent isolation in psychiatric institutions, any development of whatever faculties are present and educable in individual imbeciles can be achieved only through modern scientific methods, implemented by technically trained personnel in suitable institutions, particularly in less severely affected subjects, who constitute a transitional group toward the less severe or minor frenast(h)enics (v. MINORATI PSICOLICI).
Imbecility, in relation to the profound degenerative causes and the possible more or less manifest anatomical alterations of the encephalon, particularly of the cortical region, is not susceptible to medical treatment. When congenital syphilis is involved, a very early specific treatment is justified, from which, in some cases, one may hope for an arrest of the disease and less damage to the individual. Apart from this, treatment will remain symptomatic, particularly sedative (bromides, Luminal, etc.) in forms accompanied by excitement.
As has been said, the hereditary factor plays a strong role in the genesis of imbecility; this is not to be understood in the erroneous sense that the disease is repeated similarly and fatally in all descendants, but rather in the form of its reappearance with those characteristics of reversion and percentage proper to Mendelian alternative heredity, sometimes of a dominant type (mild forms), sometimes of a recessive type (severe forms). The so-called blastophthoria, in relation to the action of particular harmful agents (alcohol, syphilis, etc.) extrinsic to the individual, which have acted upon the plasma of the germinal cells, altering its integrity, cannot instead be regarded as hereditary in the strict sense. Through this process, frenast(h)enic individuals may be born of parents with normal intellectual development.
With regard to the administration of the Sacraments, the subject’s level of mental development must be taken into account, together with the corresponding degree of understanding and deliberateness attributable to his conscience and actions; therefore, while Baptism must always be administered, the other Sacraments will be denied, or administered conditionally or without further qualification, in those cases in which at least a minimum of disposition may be relied upon (v. Sacraments).
BIBLI: V. IDIOZIA; furthermore, V. PALMIRA, Medicina legale canonistica. Città di Castello 1946; id., Medicina forense, there 1947; F. Dominici, La medicina legale. Milan 1950. Giuseppe de Ninno