Can we diagnose a suspect?

[Errata]

I think we can probably safely say that Aaron Kosminsky, the man who was committed to an institution, had some kind of mental illness. I think it's fair to say that the reported symptoms sound a lot like what we now call schizophrenia. But I don't think we can ever know enough for a definitive diagnosis. It's possible he had a degenerative brain disorder, either genetic, or from an infection; the odds favor schizophrenia-- if the reports of his symptoms are reliable.

And here is a perfect example why attempting a lay diagnosis may be valuable. Schizophrenia is a good example, because without medical support, the deterioration of the brain is implacable. So If we say we have a suspect who through all available information was likely schizophrenic, and he was 50 years old at the time of the murders, likely he would not be the killer. 30 years of functional schizophrenia before serious structural collapse of the brain in 1888 would be extraordinary. Kosminski lived long after I would expect neurological symptoms to be catastrophic, something I can only attribute to his spending the majority of his life in the very constrained environment of the asylum. Had he still been on the streets, I think he would have died far sooner.

[RivkahChaya]

And here is a perfect example why attempting a lay diagnosis may be valuable.

Well, and there's differential diagnosis as well. If he had early onset Alzheimer's, we would expect to see movement disorder eventually; normal-onset Alzheimer's, he wasn't old enough for. Meniere's Disease sometimes results in psychotic behavior, but it's most pronounced symptom is hearing loss; that could go overlooked in initial intake in someone who didn't speak English, but not for years and years, I don't think. Tertiary syphilis usually kills more quickly, and is degenerative. If we trust the reports, Kosminski did not "go downhill" more than institutionalized people tend to from lack of stimulation; he lived much longer than people usually do after the onset of tertiary syphilis symptoms.

I could go on, but you get the idea.

One the the really makes-my-head-plotz things about people who try to diagnose illnesses in historical figures is that they usually have a pet diagnosis, and go looking for people to stick it on. First, they don't consider that someone who wasn't considered ill in there own time probably wasn't ill at all, and then second, they don't consider that even if the person was ill, they may not have the pet illness, because the same collection of symptoms can have a lot of different causes.

The common cold, the flu, and strep throat present the same initially, but the flu continues to get worse, while the cold doesn't, and with strep, the sore throat becomes very bad, and the fever gets high, but it will respond to antibiotics, while the flu won't. Usually. Some people can have a flu infection that is mild, while some people, particularly immuno-suppressed people, can have a cold that gets very bad and causes a high fever. You can also get an antibiotic-resistant strep. My husband had one once, and it was hell. If the patient is in front of the doctor, the doctor can test for strep, or the flu virus. If you are dealing with an historical figure, you have to go with the odds, pretty much, and general knowledge. If the person's neighbors had scarlet fever (somebody noted the butterfly rash in their diary), then the chance is good that he had strep. If you are intent in ferreting out every case of the flu in a particular year, because you are studying the flu, and you aren't considering other things, you are apt to see flu where it wasn't, though.

Another point, though, is that pretty much everyone during Kosminski's lifetime agreed that he had something. If reports that we have are even somewhat reliable, we can make of list of possible diagnoses, and then look at common factors. Something common to most of the things he was likely to have had is difficulty in planning tasks ahead of time. I think that makes it unlikely that he committed crimes like the ripper crimes. But that depends first on reports being reliable, and second on his having a typical run of whatever he had.

I want to keep reiterating that I wouldn't be going down the road of proposing diagnoses if it were not for the fact that he was generally believed to be not just ill, but incompetent in his lifetime. But there's also the fact that really the only thing suggesting he is was the ripper, is a single eye-witness, who, as far as we know, did not witness the actual murders.

When you look on one hand at the evidence that Aaron Kosminski had some sort of illness that makes committing these sorts of crimes atypical, and on the other hand, the word of a single witness that he was merely seen with the victim (or something), and say which is more likely, that Kosminski wasn't capable, and the witness was wrong (or just didn't see what the police thought he saw), or that all the data on Kosminski is so flawed, we can't make any kind of educated guess about him, and he was institutionalized because of some kind of family conspiracy, or as an end run around a judicial system without enough evidence, and the data may even be fake, and the witness is unimpeachable, even though no details have come down to us, I think the first one is more likely. There are, of course, other scenarios, for example, that there are two different men named Kosminski, and we have confabulated them, so the one with the disorganized thinking, and the one identified by the witness are not the same person.

Oh, man this post is long. I have more, but I'm just going to end it.

[Errata]

Well, and there's differential diagnosis as well. If he had early onset Alzheimer's, we would expect to see movement disorder eventually; normal-onset Alzheimer's, he wasn't old enough for. Meniere's Disease sometimes results in psychotic behavior, but it's most pronounced symptom is hearing loss; that could go overlooked in initial intake in someone who didn't speak English, but not for years and years, I don't think. Tertiary syphilis usually kills more quickly, and is degenerative. If we trust the reports, Kosminski did not "go downhill" more than institutionalized people tend to from lack of stimulation; he lived much longer than people usually do after the onset of tertiary syphilis symptoms.

Alzheimers causes delusions, but almost never command type delusions. Typically they stick to temporal confusion and identification delusions. Meniere's itself does not cause delusions (that I've ever heard of, though hallucinations often go with vertigo), but severe alcoholism can cause both. They could test for syphilis, and did after 1905 (I think?), so that would be in his record.

Totally just got my train of thought wrecked by a video of a water-skiing squirrel. I absolutely thought that was joke about American fair culture, but there he was. Water-skiing. It's like I have to re examine my life now. If I remember what I was going to say, I'll come back.

[RivkahChaya]

Alzheimers causes delusions, but almost never command type delusions. Typically they stick to temporal confusion and identification delusions. Meniere's itself does not cause delusions (that I've ever heard of, though hallucinations often go with vertigo), but severe alcoholism can cause both. They could test for syphilis, and did after 1905 (I think?), so that would be in his record.

Oh, I know-- and that was sort of my point about having the person in front of you. The information about Kosminski is scanty, and vague enough that if you are going around with a pet diagnosis looking for historical cases, you can probably squeeze him into several things. Schizophrenia is the most likely thing for him to have had statistically, if the historical record is correct, but that's a big if. IIRC, there is a type of Meniere's that causes panic attacks and poor impulse control, but people who have that also get bad headaches. I haven't read about it in a while. It may be that it's going under another name now.

I don't want to talk about what Kosminski had or did not have though, because we can't know. I just wanted to mention that when someone was considered ill in there own lifetime, and there is a lot of information, we can say with pretty good confidence that yes, the person had a mental illness.

When the record is lacking, we can't say anything. We cannot say, for example, that Lewis Carroll was a pedophile, just because he had a weird, kind of obsessive, hobby of photographing little girls, and didn't seem to have any normal adult romantic relationships. I know all sorts of red flags pop up, but we don't really know what happened. He seemed to be obsessed with the Liddell family in general, and it maybe that he was just shy, almost to the point of pathology, and sort of imposed himself on this family, because he was incapable of forming his own family. Or it just might have been that he like taking pictures of people, and adults didn't have the time to sit around and pose for him all day.

I also really wish the people who want to construct an incestuous relationship for Lizzie Borden and her father and then make that the motive for the murder would shut up. They know too much pop psychology, and not enough about inheritance law. Abby Borden was Lizzie's stepmother. If Lizzie's father died first, all his money, other than any specific bequests, went to Abby, and when Abby died, to Abby's family. However, if Abby died, and then Andrew Borden, everything went to Lizzie and her sister. That a really good motive right there, without any need for incest and revenge, and also explains why Abby was killed over an hour before Andrew, and the police were sent for almost immediately after Andrew was killed: his body was warm, hers was not, therefore, she died first.

That's not a "diagnosis," that's just Occam's razor. I don't know why so many people seem to want an incest backstory, unless the only way patricide can sit right with them, is if Andrew is evil. But I think they also want to find historical examples of incest, so it doesn't seem like it just started happening, because it just became news a couple of decades ago. Of course not. Of course it has always happened (it hasn't even been taboo everywhere, but when it has been taboo in some cultures, you know someone must have been doing it, for it to be labeled as off-limits). It isn't necessary to list specific cases throughout history to prove this.

[Errata]

I don't want to talk about what Kosminski had or did not have though, because we can't know. I just wanted to mention that when someone was considered ill in there own lifetime, and there is a lot of information, we can say with pretty good confidence that yes, the person had a mental illness.

In truth, I don't mind people bandying about ideas about historical figures who quite frankly can't be harmed by our notions as they tend to be safely dead. I would never do it to a living person, except I have recommended a few friends see a psychiatrist because I was pretty convinced that what they called "quirks" were actually a treatable condition. I think Stonewall Jackson is a very peculiar choice to an Aspergers diagnosis, But I'll listen to it, probably argue it. What I cannot abide is people who then present this as fact. "Jackson had Aspergers." Shut up. You have no idea.

Something was wrong with Kosminski. To the point that to an extent he cooperated with his own commitment. Now whether or not a suspect was mentally ill is really only relevant if that mental illness either caused the behavior in question, or informed it. Otherwise, it's just a coincidence about as relevant as the amount of teeth the guy had. Except with one caveat. If he was known to be insane, he would send up red flags wherever he went, which can make it extra hard to escape notice. But the type of disorder can dictate functionality, organization, executive function, even difficulties. And that's important in understanding the actual commission of the crime.

[RivkahChaya]

In truth, I don't mind people bandying about ideas about historical figures who quite frankly can't be harmed by our notions as they tend to be safely dead.

It bothers me, because those idea become fact pretty quickly. You wouldn't believe how many people now "know" for a "fact" that Einstein had Asperger's. No, he did not. He didn't because it is impossible to diagnose an historical figure, and because he functioned too well on a day-to-day basis.

What is problematic, though is not that it affects Einstein in any way, but that it affects people who really have Asperger's. If Einstein and Stonewall Jackson become the public face of Asperger's-- that's even worse than when Dustin Hoffman in Rain Man was the public face of autism.

People with Asperger's aren't brilliant and quirky, and if you just leave them alone, they'll go invent something that will change the world, but you would not believe how many people I have encountered who think this, and they think this because they have never met anyone with the actual diagnosis, just read blogs where people who read other blogs speculate who among the famous went around undiagnosed in past centuries.

People with Asperger's syndrome are more like you and me than they are like Einstein (for as much as I actually know about Einstein), but they do have some problems, and need extra help, and a little understanding when they are socially awkward. The last thing they need is to be held to a higher intellectual standard than everyone else, because Asperger's means they are socially awkward, and a little compulsive, but also have a superpower that will emerge at some point.

Something was wrong with Kosminski. To the point that to an extent he cooperated with his own commitment. Now whether or not a suspect was mentally ill is really only relevant if that mental illness either caused the behavior in question, or informed it.

I feel the same. If he behaved in general the way he behaved for the people who evaluated him in the institution, I think the victims would not have let him get near them. They would probably have been on the lookout for other things that were considered red flags in 1888, which are no longer, like stuttering, and that probably lets Lewis Carroll off the hook. They probably would have avoided people whose appearance or movement was odd, even if they were totally normal, with an essentially benign condition, like Apert's syndrome (causes a sort of bug-eyed look, like Peter Lorre, only much more pronounced), or mild cerebral palsy.

So, yeah, I think it's a difficult balancing act. We certainly can't diagnose Kosminski with a axis-I, axis-II, this that, but I think we can't be so agnostic as to say that everything is unknowable, so Kosminski is a viable suspect. I think we can say "Yes, he had some sort of pathology that affected his behavior," and then stop there. And I think that for our purposes, that's all we need to say, because that's enough to speculate that women on high alert in the fall of 1888 would not solicit him.