discussion of Aaron Kosminski's psychological profile

[Versa]

Hi Versa

Interesting idea. However I would have thought that when the cause of Aaron's illness was changed from "unknown" to "self-abuse," that would have reflected Victorian belief in masturbation as a cause of mental illness (which is silly) rather than physical self-harm as a cause of mental illness (which is less silly but not the kind of cause that would leap to mind). Someone who, say, stabs himself in the arm every so often or sticks pins in himself, might drive himself into a bad mental state but it seems to me less likely that this is what was meant. The Victorians probably would have seen self-harm as a symptom of mental illness rather than a cause, as indeed they should have seen excessive masturbation.

Hi,

lol Ive just started a thread about the possible meaning of the term (so as not to derail this thread or have the discussion lost) and your answer here does sound reasonable... I'm unsure atm what the Victorian view of self harm was?

[Robert]

Hi Versa

Interesting idea. However I would have thought that when the cause of Aaron's illness was changed from "unknown" to "self-abuse," that would have reflected Victorian belief in masturbation as a cause of mental illness (which is silly) rather than physical self-harm as a cause of mental illness (which is less silly but not the kind of cause that would leap to mind). Someone who, say, stabs himself in the arm every so often or sticks pins in himself, might drive himself into a bad mental state but it seems to me less likely that this is what was meant. The Victorians probably would have seen self-harm as a symptom of mental illness rather than a cause, as indeed they should have seen excessive masturbation.

[Versa]

Perhaps they didn't have a term for 'self-harm' because the media hadn't yet promoted it....

Hi,

Self harm was about even prior to the more recent explosion in people self harming. I'm just not sure what terminology was used by the staff at the time and self-abuse seems like a possible term.

Its possible that the term was then applied to masturbation at a later date but I really don't know....

[Versa]

Hi Versa

No, I corrected myself after. The term was used, but I think it meant "masturbation."

Ah ok

Personally I'm undecided yet whether the term self-abuse was meant in the sexual way or if it meant self-harm or self-injury... I need to read his notes as if that term coincides with periods in which he is displaying more negative symptoms (poor hygiene, apathy etc) I might be more inclined to believe it referred to his injuring himself.

The reason this is of interest to me is that a person that self harms is one that turns their anger/hatred in on themselves and tends to be less inclined to harm others. Obviously that would might us some more insight into Aaron's personality type.

[Versa]

According to some admittedly slightly outdated books, only 40% of schizophrenics are symptomatic by 19.

The term 'symptomatic' might mean anything really, the person could of been displaying symptoms such as becoming withdrawn, isolating them selves etc or more distressing symptoms may be present....

And if it was surprising, does that mean we have to try and scale back the symptoms to something more age appropriate, or alter the perceived diagnosis? In other words, how many of the symptoms described in 1894 are likely to be present 6 years earlier?

My personal feeling is that Aaron was a 'slow onset, long lasting' Schizophrenic, lots of people that develop very severe symptoms (such as Aaron) do very well at school both academically and socially maybe even holding down a job for a couple of years 18-24 would be when I'd expect people outside the family to notice things.

I haven't read through all Aaron's notes (yet)but I would imagine that he would be displaying 'odd' behaviour in public by 18-24ish but I couldn't say to what degree atm (and dependant on his notes might not be able to ever)

On a somewhat tangential note, it would be nice if the numbers existed as to how much time families spent with the mentally ill before institutionalizing them. Given the attitudes of the day, 6 years with a full blown schizophrenic seems like an extraordinarily long time.

I wouldn't imagine that his behaviour would make him too difficult to live with initially but every person is different and the illness can manifest to varying degrees in different people.... Also a Jewish or even working class family might be less inclined to have a family member placed in an institution due to either the stigma or concerns for their welfare in the institution. Many families kept these things quiet and did their best to care for the family member until it really did become impossible.

If he's just responding to voices (auditory hallucinations) or occasionally watching something that isn't there (visual hallucinations) then he might be perfectly easy to live with.

If he's paranoid and/or delusional then that would depend to some extent on what he was paranoid about and to what degree...

For example if he was paranoid that his sister was trying to poison him (a common example) then he might become more difficult to live with depending on whether he voiced his concerns or kept them quiet and just refused food cooked by her.

If for example he was delusional and paranoid that blue men from the moon where after him when he was out but felt safe at home then he might not be difficult to live with, on the other hand if the paranoia meant that he was barricading doors or thought that his sister was a blue man from the moon in disguise then again he would be more difficult to live with!

So its all down to the individuals delusions etc not necessarily the behaviour of a person with schizophrenia.

Hope that all made sense

[Robert]

Hi Versa

No, I corrected myself after. The term was used, but I think it meant "masturbation."

[Versa]

Hi Versa

I don't recall the term "self-abuse" cropping up in connection with Aaron. Macnaghten's "many years' indulgence in solitary vices" makes it clear that it was masturbation that was meant.

Thanks for clearing that up, I'd got confused somewhere in the thread I thought that the term had been used in connection with Kosminsky

Of course, if practised excessively this might cause physical damage of some sort.
"They say harm can come to a young lad like that."

I think blindness is a big risk

[Chris]

I think I may have a different Birth date that would put him at 24, which my math was based off of.

My thinking was this: If Kosminski was 24 at the time of institutionalization, and that was in 1894 (which could also be wrong) that would make him about 18 at the time of the murders. According to some admittedly slightly outdated books, only 40% of schizophrenics are symptomatic by 19. But I realize statistics are one thing and the real world another, so I was curious as to how surprising it would be to someone who works in the profession.

Thanks to Rob's researches we know he was born on 11 September 1865, so he turned 23 in the Autumn of 1888, and was 25 when Houchin recorded his symptoms on 6 February 1891.

[Errata]

I would however quite happily rule out Bi-polar as what we do have indicates very classic Schizophrenia and none of the classic signs of Bi-Polar. In other words we're looking at a psychosis with labile affect (changeable mood) rather than an affective disorder with psychotic elements.

Well, as someone who has Bipolar and is marrying someone with Bipolar and spent a lot of time with other Bipolar kids, I have to agree.

Not that Bipolar people can't be violent, but I think we'd make terrible serial killers. Spree killers sure, but not serial killers. Unmedicated we pretty much have no ability to pursue long term goals.

[Errata]

Maybe I'm misunderstanding, but Aaron Kozminski was 25 at the time when Dr Houchin recorded his symptoms.

I think I may have a different Birth date that would put him at 24, which my math was based off of.

My thinking was this: If Kosminski was 24 at the time of institutionalization, and that was in 1894 (which could also be wrong) that would make him about 18 at the time of the murders. According to some admittedly slightly outdated books, only 40% of schizophrenics are symptomatic by 19. But I realize statistics are one thing and the real world another, so I was curious as to how surprising it would be to someone who works in the profession.

And if it was surprising, does that mean we have to try and scale back the symptoms to something more age appropriate, or alter the perceived diagnosis? In other words, how many of the symptoms described in 1894 are likely to be present 6 years earlier?

On a somewhat tangential note, it would be nice if the numbers existed as to how much time families spent with the mentally ill before institutionalizing them. Given the attitudes of the day, 6 years with a full blown schizophrenic seems like an extraordinarily long time.

[Robert]

Hi Greg

Our posts crossed. I have just now corrected myself, as Murray Walker might have said.

[Robert]

Sorry, forgot about Jacob Cohen. I think though that the solitary vices reference makes it clear what was going on.

[GregBaron]

Stop doing that...

Hi Versa and Robert,

I do think they used the term 'self-abuse' when Koz was incarcerated. One wonders why they called it abuse when it's supposed to feel good. I guess the Victorian motto was 'if it feels good don't do it'...

Perhaps they didn't have a term for 'self-harm' because the media hadn't yet promoted it....


Greg

[Robert]

Hi Versa

I don't recall the term "self-abuse" cropping up in connection with Aaron. Macnaghten's "many years' indulgence in solitary vices" makes it clear that it was masturbation that was meant.

Of course, if practised excessively this might cause physical damage of some sort.
"They say harm can come to a young lad like that."

[Versa]

So, in your tenure with taking care of the mentally ill, would you be surprised to learn that someone with such a severity of symptoms as Kosminski was only 18? And if so would it change your assessment? Would you keep it in the Schizophrenia family, or would you think it would have to be some other disorder that shows symptoms earlier than Schizophrenia?

No I wouldn't be that surprised, Schizophrenia can and often does appear in late teens, the negative symptoms (apathy etc) tend to be less with teenagers, however Schizophrenia that occurs in late teens often 'burns out' fairly quickly, some people might experience a few months of illness others a couple of years, sometimes leaving the person quite developmentally damaged (poor social skills, emotionally immature etc) but sometimes the person makes a complete recovery.

Whether or not you want to 'label' this as a different illness isn't my place to debate and the only reason in my experience that the diagnosis may be deferred when it comes to a teenager is due to the social stigma and the impact a diagnosis of schizophrenia can have on someone, this 'labelling' is avoided where possible with a teenager in an attempt to avoid further impact on their lives if possible.

If however the person was in their early 20's when they first showed signs of Schizophrenia the symptoms both negative and positive would be much more likely to remain quite florid throughout the persons life in varying degrees (worse some weeks than others) and the negative symptoms tend to become more life impacting, delusions become more 'set'.

Having said all that I've nursed some very, very poorly teenagers some of whom have gone on to live very productive 'normal' lives and others who have remained 'revolving door patients' all their lives and never made a good recovery or been well for any length of time.

There's a general rule of thumb that a teenager developing Schizophrenia will make a better recovery than a person that develops it from their 20's onwards but like anything there are always exceptions to the rule.

I also don't think at all that we can in any way pace a more specific diagnosis on a person for whom we have a few sparse notes from 120yrs ago. Its possible that schizo-affective could be a diagnosis but we don't have the information to make that sort of diagnosis.

I would however quite happily rule out Bi-polar as what we do have indicates very classic Schizophrenia and none of the classic signs of Bi-Polar. In other words we're looking at a psychosis with labile affect (changeable mood) rather than an affective disorder with psychotic elements.

I was under the impression though that Kosminsky was considered somewhat older than 18?
I still wonder if the term 'self abuse' be referring to 'self harm'?