PATHOLOGICAL CONDITIONS. — This designation generally refers to morbid conditions and organic or functional anomalies that cause more or less distressing physical, psychological, or psychophysical suffering.
I. P. S. IN THE BROAD SENSE. — They include diseases above all. Considering that human life is threatened by physical agents (e.g., heat, electricity), chemical agents (e.g., caustic acids and alkalis), microbes, parasites, etc., the state of health may be defined as the organism’s victorious condition in the face of the hazards of the environment in which it lives, marked by the normal performance of vital functions and by a sense of well-being. Conversely, disease is the result of the unequal struggle waged by the organism against harmful agents.
The signs of disease, understood in the sense indicated above, are not recognizable in all pathological states; in such cases one speaks of anomalies.
The boundaries between the so-called personal variants, which fall within the variability of « types » (v.) and anomalies are uncertain; for this reason, the statistical criterion alone is not always sufficient to determine whether one is dealing with a pathological state. Other elements then provide assistance: for example, in cases of psychopathy, Jaspers attaches importance to the harmfulness of the anomaly; Schneider defines the psychopathic personality (v) as an anomalous personality that suffers and causes suffering. The criterion of anomaly in the statistical sense also applies to physical defects falling within the category of congenital malformations; the definition of diseases cannot be applied to them either, since the organism’s reaction directed toward restoring the state of health is absent. The same may be said of many physical defects resulting from trauma and surgical procedures (amputations, ankyloses, etc.). Not only is it difficult in some cases to distinguish personal variants from anomalies properly so called, but it is even arduous to separate the state of illness from that of health. There are phenomena that do not substantially disturb subjective and objective well-being and therefore do not render the subject ill in the strict sense of the expression, even though he has lost his anatomical and functional integrity. These individuals often present transient functional imbalances and brief indispositions, which are promptly repaired by recuperative powers; at other times the functional imbalances are permanent but slight in degree and duration: the patient’s health does not appear to be obviously compromised and he continues to work, but the work proves unusually burdensome to him, and his output is lower in both quantity and quality. Some pathological states may manifest themselves through external symptoms so characteristic that a general diagnosis can be formulated or suspected on the basis of those symptoms alone.
II. S. P. IN THE STRICT SENSE. — The term s. p. in the narrower sense also designates certain particular morbid conditions and particular physical and psychic anomalies, characterized by certain distinctive symptoms.
From a general point of view, s. p. may fall within the province of medicine or surgery. Every s. p. entails suffering of varying intensity, affecting both body and spirit; at times the latter is considerable even in physical illnesses and requires therapy that must not be neglected. The physician will fully accomplish his mission if, while treating the body, he also takes into account the needs of the spirit. But above all, his office will approach the priesthood if, in disturbances of the spirit that interfere with morality, he knows how to be for the patient a wise healer and an enlightened counsellor.
III. PATHOLOGICAL STATES IN RELATION TO IMPUTABILITY
The diagnosis of p. s., especially of those that are unrecognized and of slight degree, has practical, pastoral, and medico-legal importance: it prevents harm by asking an individual to do more than he is capable of doing; it makes timely treatment possible; and it allows well-considered judgments to be made concerning responsibility for actions carried out under abnormal psychophysical conditions. It is well known that, because of the relations existing between body and spirit, many diseases and bodily anomalies are reflected in the spirit in such a way as to attenuate or abolish the free choice of the will. In general, imputability is neither left intact nor wholly removed (except in extraordinary cases), but is diminished.The enunciation of this principle in the subjects under consideration concerns only acts caused in them by the abnormal state, and not those which they perform wholly independently of the influence of the abnormality. Nor does it concern indirect imputability or imputability in causa, whether with regard to the abnormality itself or to its effects. Another rule to be followed in practice, so as not to worsen the condition of these impaired persons, is to deal with them, both in direction and in confession as well as in ordinary life, with gentleness, without either excessively diminishing their imputability by means of nonexistent excuses or ever entirely disregarding their abnormal state.
In the external forum the CIC considers the extreme forms of these anomalies; but the norm for the extreme degrees also contains the rule to be followed, with due proportion, in ordinary cases. “Those who lack the use of reason are incapable of committing a delict” (can. 2201 § 1). The habitually insane, even though they may at times have lucid intervals, or may appear sane in certain reasonings or acts, are nevertheless presumed incapable of committing a delict (can. 2201 § 2). A delict committed in voluntary drunkenness is not without some imputability, but this is certainly less than that of one who commits the same delict in full possession of his faculties, unless, however, the drunkenness was deliberately induced in order to commit or excuse the delict; if the law is violated in involuntary drunkenness, imputability is entirely absent if the drunkenness has wholly removed the use of reason; it is merely diminished if the use of reason has been removed only in part. The same is to be said of other similar disturbances of the mind (can. 2201 § 3). “Weakness of mind diminishes the imputability of the delict, but does not remove it entirely” (can. 2204 § 4). In the light of these principles, judgment must be made concerning the various persons affected by such p. s., and cann. 2218 and 2229, relating to penalties, must be applied.
It should be remembered that, according to the same CIC, “all those who habitually lack the use of reason are assimilated to children” (can. 88 § 3), and “those baptized persons who do not enjoy a sufficient use of reason are not bound by ecclesiastical laws, nor are those who, although they have attained the use of reason, have not yet completed their seventh year, unless the law expressly provides otherwise” (can. 12). In view of this, the provisions of the CIC concerning the domicile (v.) of minors and impaired persons (can. 93 § 1), concerning the right of suffrage, which is not granted to them (can. 167 § 1, n. 1), concerning the measures to be taken by the judge (cann. 1648 § 1 and 1650) in cases of lack of the use of reason, and the conditions required of the subject with regard to Baptism (cann. 745 §§ 2, n. 1, and 754), Confirmation (cann. 786, 788), the Eucharist (cann. 853, 854, 859, 860), Penance (can. 886, 887 § 1, 906), Extreme Unction (cann. 940 § 1, 941, 943, 944 and 947 § 1), Holy Orders (cann. 968, 970, n. 2), and Matrimony (cann. 1081 and 1082) are readily understood.