NARCOANALYSIS. — Exploration of the psyche by means of pharmacodynamic substances of the barbituric type, which induce an artificial state of subnarcosis.
The first attempts to study mentally ill patients in a state of subnarcosis date back to Long (1842), who used ether, and to Moreau (1845), who employed hashish; much later (1909) came the experiments of Silberer and Sidis and those of Claude, with ether, in an attempt to unlock the block, the *Sperrung* of schizophrenics. Laignel-Lavastine tried a barbiturate, *membru*, intravenously, to “externalize” the feelings of the sick. The interesting observations of Palmieri on the experimental exploration of the psyche by means of mescaline date from 1938–40. But the current development of n. is due above all to the Anglo-Saxons (J. Stephen Horsley, 1936), who, during the last war, widely employed 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 varying quantities of solutions of *farmato*, *amiat*, sodium, *pentothal* sodium, *nésodio*, *isomyl*, etc. Some prefer to begin the interrogation when the patient falls into the twilight state, others when he begins to awaken. Regardless of the point of attack, the mesencephalon-diencephalon, and the purely neurological phenomena presented by the subject in a state of subnarcosis, today it is agreed to admit that psychologically there is a disappearance of the higher psychic functions (intellectual synthesis, concentrated attention, criticism); on the other hand, the fundamental functions of psychic life, of a psycho-neurological character, seem to be completely preserved, such as, for example, provoked attention, orientation, perceptions and some 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 rational power, there is an easier and stronger emergence of mnemonic images, especially those solicited by affective moments. Thus, on the one hand the perceptual door is opened, and on the other the possibility of elaboration of the fundamental elements of psychic life, of perceptual and mnemonic images, on a plane of simple affectivity and therefore easily suggestible. A similar condition seems able to explain, though not decisively, the probable mechanism of action of subnarcosis. With the use of n., three types of results can be schematically obtained: a) absolutely negative; b) partially positive, in which the patient declares himself satisfied, tranquil, euphoric, reports anamnestic details about which he previously remained silent; c) frankly positive, in which the patient takes the initiative, showing an uninterrupted series of anguished expressions, or indeed a true emotional crisis of a neurotic nature, during which he evokes events or recalls persons closely linked to his intimate life or to his morbid state. Sometimes a dreamy state appears, with spontaneous phrases revealing a possible delirium, whose existence had only been suspected or barely glimpsed; above all, if there was previously resistance or hostility, a release, an abandonment is observed, which in some cases can be truly surprising. Indeed, some, as soon as questioned, easily and richly report a whole series of new delusional interpretations or hint at hallucinations that had hitherto been concealed. This is a true Narcotest that allows for a “rapid pharmacogenic diagnosis.”
Recently, for current psychodiagnostic use, “amphetamine” (or methedrine or *weekamin* or pervitin) has been introduced, a powerful sympathomimetic injected intravenously in quantities of 20–30 mg. The so-called “amphetamine shock” (Delay) is obtained, 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 n. has a depressive action on emotional and mental tone and lowers psychological tension (i.e., it is said to have a “psycholytic effect”), “week-analysis” stimulates and increases tension, i.e., it exerts a psychotonic action. Thus, week-analysis, by accentuating psychopathological traits, facilitates diagnosis, proving very useful in cases of reticence. Today the pharmacodynamic exploration of the psyche has entered into ordinary psychiatric diagnostic practice, even though its heuristic value is increasingly limited, especially with regard to n. However, one cannot deny n. a considerable therapeutic value: subnarcosis, in fact, by partially removing censorship and weakening inhibitions, determines a dissolution of the intellectual, rational and social powers of the personality, allowing the liberation of instinctive, affective and autistic tendencies and thus the resolution of various neurotic conflicts. According to some authors, this would be a simple psychotherapy with analysis, the latter being facilitated by the reduction of anxiety through the medication.
The ethical-legal problems regarding subnarcosis arise from the well-established fact that (at least in most cases) n. causes a dissolution of the intellectual and volitional powers of the personality: this is a profound alteration of the structure of the personality, a true infringement of the laws of defense. One must therefore admit a serious attack on individual freedom, i.e., on a fundamental property of human personality. For this reason, legal physicians, psychiatrists, jurists, and moralists have passionately debated the liceity of recourse to n., especially in judicial expertise.
The use of n. for purely medical, diagnostic and therapeutic purposes is legitimate, provided that the physician is conscientious and competent and that he respects professional secrecy. The patient’s consent is, moreover, normally required: this can be dispensed with only when the method of cure is imperative and the subject is deprived of knowledge. As for the use of narcosis to establish in judgment the guilt of a person, almost all authors agree in denying the liceity of n. Although they consider that such a test does not constitute an attack on the physical integrity of the accused, it is regarded as an assault on an absolute right of the human person, namely freedom. If the person under examination refuses to submit to n., as well as to other investigations (lumbar puncture, encephalography, electroencephalography, blood alcohol level, blood grouping), the expert cannot carry out any examination, and this cannot constitute an argument in favor of 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. Can. 1743 of the CIC, in fact, states: *“Judici legitime interroganti partes respondere tenentur et fateri veritatem, nisi agatur de delicto ab ipsis commisso a* [the accused] *ipse patratum*.” By expressly recognizing the presumed guilty party’s right to conceal his own crime, one logically rejects n. as a means of obtaining information or confessions for the purposes of criminal investigation. It remains to be seen whether the use of n. is licit for other purposes of legal medicine (e.g., to demonstrate non-guilt) or for scientific purposes.
There is less agreement on this point; authoritative voices have recently maintained that n., not being intrinsically illicit, is not only legitimate but also necessary in forensic medicine. An accused person must never be deprived of the advantages it may afford; thus science must not renounce any useful method, which in itself is never illicit. The use of narco-diagnosis must naturally remain in the hands of competent physicians, solely for the purpose of medical diagnosis, with the utmost respect for the patient’s free consent (Heuyer 1949). There are, however, those who oppose its scientific use (e.g., M. Janssen), given the delicacy of the investigation, in which the advantages do not outweigh the disadvantages, and its use in favor of the accused (e.g., J. Rolin).
It must indeed always be borne in mind that a purely scientific evaluation of n. does not permit it to be regarded as evidentiary proof. It is now well established (Redlich) that only individuals prone to confession, with unconscious self-punitive tendencies, can be induced to speak under sub-narcosis (Freud calls such persons “moral masochists”); indeed, they may even admit to crimes they have not committed, in order to relieve their sense of guilt. Conversely, n. is not capable of abolishing, in normal individuals, a certain degree of censorship when it comes to revealing serious matters; experimentally, it has been observed that during sub-narcosis, defensive covering mechanisms (“cover stories” of Redlich and Ravitz) can be maintained, even in the absence of a threat of guilt or social sanction—that is, with an emotional context far more ready to defend itself. There can be no doubt, therefore, that it is inaccurate to speak, in an absolute sense, of a “truth serum.”
From a psycho-sociological standpoint, n. can be of considerable utility in relation to social security (protection of society against juvenile delinquents), as an auxiliary means of determining educational measures useful for the rehabilitation of the child (provided he consents); moreover, its use appears to be a valid aid in studying the psychological, especially emotional, origins of crime. Since it is a means that can easily lend itself to abuse, it is essential that it be employed by physicians who are not only technically but also morally prepared.