Narcoanalysis

NARCOANALYSIS. - Exploration of the psyche by means of pharmacodynamic substances of the barbiturate type, which induce an artificial state of subnarcosis.

The first attempts to study the mentally ill in a state of subnarcosis date back to Long (1842), who used ether, and to Moreau (1845), who made use of hashish; much later (1900) came the experiments of Silberer and Sidis and those of Claude, with ether, in the attempt to unblock the impasse, the Sperrung of schizophrenics. Laignel-Lavastine tried a barbiturate, nembutal, intravenously, in order to "externalize" the feelings of the sick. From 1938-40 date the interesting observations of Palmieri on the experimental explorations of the psyche by means of mescaline. But the present development of narcoanalysis is due above all to the Anglo-Saxons (J. Stephen Horsley, 1936) who, during the last war, made extensive use of this method on their neurotic soldiers.

The technique consists in the intravenous injection, more or less rapid, according to the different methods, of 8-10 cc. of a 10% solution of narcovene or of different quantities of solutions of farmotal, sodium amytal, sodium pentothal, nesdonal, isomyl, etc. Some prefer to begin the interrogation when the patient falls into the twilight state, others when he begins to awaken. Apart from the point of attack, mesencephalic-diencephalic, and from the purely neurological phenomena that the subject in a state of subnarcosis presents, today it is agreed in admitting that psychologically one observes the disappearance of the higher psychic functions (intellectual synthesis, concentrated attention, critical faculty); on the other hand, the fundamental functions of psychic life, of a psycho-neurological character, appear completely preserved, such as, for example, provoked attention, orientation, perceptions and certain mnemonic activities, with the presence of hypermnesias; the latter are probably facilitated by the fact that, since mnemonic activity is no longer at the service of a lucid and selective reasoning power, there is an easier ecthoria of mnemonic images, solicited above all by affective moments. Thus, on the one hand the perceptive door is open, on the other the possibility of elaborating the fundamental elements of psychic life, of perceptive and mnemonic images, on a plane of simple affectivity and, therefore, easily suggestible. Such a condition seems able to explain, although not decisively, the probable mechanism of action of subnarcosis. With the use of narcoanalysis one can have, schematically, three types of results: a) absolutely negative; b) partially positive, in which the patient declares himself satisfied, calm, euphoric, reports anamnestic particulars about which he had previously kept silent; c) frankly positive, whereby the patient takes the initiative, showing an uninterrupted series of anguished expressions, or, indeed, a true emotional crisis of a neurotic stamp, during which he evokes events or recalls persons closely bound to his intimate life or to his morbid state. At times a dreamlike state manifests itself, with spontaneous phrases revealing a possible delirium, whose existence had only been suspected or barely glimpsed; one observes, above all, if previously there was resistance or hostility, a relaxation, an abandonment that, in some cases, can be truly surprising. Indeed some, as soon as they are questioned, report with ease and wealth of detail a whole series of unpublished delirious interpretations or allude to hallucinations that until then had been hidden. It is a true Narcotest that permits a "rapid pharmacogenic diagnosis."

Recently, for the current psychodiagnostic use, "amphetamine" (or methedrine or weckamine or pervitin) has been introduced, a powerful sympathomimetic that is injected intravenously in quantities of 20-30 mgr. One obtains the so-called "amphetamine shock" (Delay), with a strong excitation of the impulse to speak: the formation of associations and verbal formulation are facilitated, the flow of thought is increased; whereas narcoanalysis has a depressive action on the emotional and mental tone and lowers psychological tension (one speaks, that is, of a "psycholytic effect"), "Weck-analysis" stimulates and increases tension, that is, it exerts a psychotonic action. Therefore Weck-analysis, by accentuating the psychopathological characters, facilitates diagnosis, proving of great utility in cases of reticence. Today the pharmacodynamic exploration of the psyche has entered ordinary psychiatric diagnostic practice, even if there is an increasing tendency to limit its heuristic value, especially with regard to narcoanalysis. One cannot, however, deny narcoanalysis a notable therapeutic value: subnarcosis, in fact, by paralyzing the censorship and weakening the inhibitions, determines a dissolution of the intellectual, rational and social powers of the personality, permitting the liberation of instinctive, affective and autistic tendencies and therefore the resolution of various neurotic conflicts. According to some authors it would be a simple psychotherapy with analysis, the latter facilitated by the diminution of anxiety obtained by means of the medicament.

The ethical-legal problems concerning subnarcosis arise from the fact, now well accepted, that (at least in the majority of cases) narcoanalysis provokes a dissolution of the intellectual and volitional powers of the personality: it is a profound alteration of the structure of the personality, a true infraction of the laws of defense. One must therefore admit a grave attack on individual liberty, that is, on a fundamental property of the human personality. For this reason forensic physicians, psychiatrists, jurists, moralists have discussed with passion the lawfulness of recourse to narcoanalysis, especially in judicial expert testimony.

The utilization of narcoanalysis for a purely medical, diagnostic and therapeutic purpose is legitimate, on condition, however, that the physician be conscientious and competent and that he respect professional secrecy. The consent of the patient is on the other hand normally required: one can dispense with it only when the method of treatment is imperative and the subject is deprived of consciousness. As regards then the employment of narcosis to establish in judgment the guilt of a person, almost all authors are in agreement in denying the lawfulness of narcoanalysis. Although holding that such a proof does not constitute in any way an attack on the physical integrity of the accused, it is nevertheless regarded as an attempt against an absolute right of the human person, liberty. If the person undergoing examination refuses to submit to narcoanalysis, as likewise to the other investigations (lumbar puncture, encephalography, electroencephalography, alcohol level, blood individuality), the expert cannot perform any examination and this cannot constitute an argument against the accused "Verboten (n.) in der gerichtlichen Untersuchung und im Strafprozess; sie ist unrichtig und irreführend" (Schönke-Cremerius, 1950-51).

Such opinions coincide perfectly with the arguments of moral theology, canonized by the law of the Church. Canon 1743 CIC, in fact, expresses itself thus: "Judici legittime interroganti partes respondere tenentur et fateri veritatem, nisi agatur de delicto ab ipsis commisso." By expressly recognizing in the presumed guilty party the right to conceal his own crime, one arrives at the logical rejection of narcoanalysis as a means to obtain information or confessions for the purposes of the criminal investigation. It remains to be seen whether the employment of narcoanalysis is lawful for other purposes of forensic medicine (for example, in order to demonstrate non-guilt) or for scientific purposes.

Here there is less agreement of opinions; authoritative voices have recently affirmed that narcoanalysis, not being intrinsically illicit, is not only legitimate but also necessary in forensic medicine; an accused person must never be deprived of the advantages he may receive from it; thus science must not renounce any useful method, never in itself illicit; the use of the narcotic drug must naturally always remain in the hands of competent physicians, for the sole purpose of a medical diagnosis, with the utmost respect for the free consent of the patient (Heuyer 1949). Nor is there any lack, however, of those who are opposed both to its scientific use (e.g., M. Janssen), given the delicacy of the investigation, in which the advantages do not outweigh the disadvantages, and to its use in favor of the accused (e.g., J. Rolin).

It must in fact always be borne in mind that a purely scientific evaluation of narcoanalysis does not permit it to be considered as evident proof of judgment. It is today well demonstrated (Redlich) that only individuals inclined to confession, with unconscious self-punitive tendencies, can yield to interrogation under subnarcosis (Freud calls these people "moral masochists"); indeed, they can even acknowledge themselves guilty of a crime they have not committed, in order to save themselves from the sense of guilt. Nor, conversely, is narcoanalysis capable of abolishing, in normal individuals, a certain degree of censorship when it is a matter of grave revelations: experimentally it has been observed that during subnarcosis defensive cover mechanisms can be maintained ("cover stories" of Redlich and Ravitz), and this even in the absence of a threat of guilt and of a social sanction, that is, with an emotional fabric of the situation far more ready for defense. There is therefore no doubt that it is inaccurate to speak, in an absolute sense, of a "truth serum."

From a psycho-sociological point of view, narcoanalysis can be of considerable usefulness in relation to social security (protection of society against the juvenile delinquent), as an auxiliary means for determining the educational measures useful for the rehabilitation of the child (provided that he consents); moreover, its employment seems to be of valid help in the study of the psychological, especially emotional, origin of crime. Since, however, it is a means that can easily lend itself to abuse, it is indispensable that it be used by physicians who are prepared not only technically but also morally.

pp. 393-400; L. Massion-Vernior, Que faut-il penser de la narco-analyse?, in La revue nouvelle, 6 (1949, 11), pp. 116-27; J. Rolin, Le pentothal en justice, in Etudes, 216 (1940), pp. 231-37; L. Bertagna, Le mythe du sérum de vérité, in Cahiers Laënnec, 3 (1949), pp. 4-18; A. Odinot, Le droit au silence, ibid., pp. 19-33; P. Gournelli, Le droit à la preuve, ibid., pp. 34-52; Ch. Latère, De l'expertise mentale, ibid., pp. 53-63; F. Dominici, La n. nella prassi medico-legale, in Minerva Medica, 17 (1949), p. 505; J. Deluy, Méthodes biologiques en clinique psychiatrique, Parigi 1950; E. Boné, Quelques précisions techniques sur la narcoanalyse, in Nouvelle rev. théol., 72 (1950), pp. 184-92; M. Thierry, La narco-analyse et la morale, ibid., pp. 192-98; V. PALMIRA, La n. sotto il profilo medico-ginédico ed etico-deontologico, in Atti del IV Conor, internaz. des medici cattolici, Roma 1950, p. 161 sgg.; E. Boganelli, Corpo e spirito, ivi 1951, pp. 191-98; A. Schönke, Juristische Fragen der psychiatrischen Praxis, in Nervenarzt, 22 (1951), p. 161; F. C. Redlich, L. J. Ravitz, C. H. Desson, N. and Truth, in Amer. J. Psychiat., 1951, pp. 107, 586; H. W. Janz, Die diagnostische Verwendbarkeit der Wechsauversprungen der Psychopathologie, in Nervenarzt, 22 (1951), p. 45. Altra bibl. interessante in Rev. diocés. de Tournai, 5 (1950), pp. 254-60. Bruno Callieri