Is There a Relation Between Kleptomania and Female Periodicity in Neurotic Individuals?
- Author:
Warren C. Middleton
DePauw University
There has recently come under my observation the rather unusual case of a girl who exhibits kleptomaniac tendencies only during her menstruation periods. A diagnosis of kleptomania seems to be fully justified, although the author is not unmindful of the fact that genuine cases of this disorder are exceedingly rare, and that kleptomania is not only subject to wide variation in definition, but is, as well, amenable to unscientific diagnosis. The more pertinent facts involved in the case are as follows: Girl, nineteen years of age. A college freshman with a general intelligence level slightly below the average. Mother died when patient was six years of age; father married again about three years ago. Patient has an uncontrollable impulse to steal, without any real desire for the thing stolen. The stealing is of a motiveless kind and is sometimes done in a very childish manner. She has plenty of means. A very careful check-up has revealed that she frequently is guilty of theft during her menstrual periods, but apparently at no other time. Stealing was observed during several menstrual cycles in succession, but never during the intervening periods. Patient is inclined to be unstable and neurotic, but under ordinary circumstances adjusts herself in a fairly adequate manner. During menstruation she appears to be somewhat confused (says she is “dazed”). Sometimes she faints and appears to be slightly amnesic afterwards; but, she says, “I suddenly seem to come to myself.’’ She complains that the menstrual pain is ‘’ unbearable,’’ so intense at times that she does not seem to know what she is doing. When she realizes that she has been guilty of theft, she cannot account for her misdeed and is usually very much ashamed of herself. At the time of the last report, made during menstruation, she regained consciousness from a fainting spell, inquiring repeatedly, ‘’ doesn’t think that I took her money, does she ?’’ After each offense, she promises faithfully that she will not re232 peat it, but, with her next menstrual period, her tendency to kleptomania reappears.
In the light of the above case, in which kleptomania accompanies menstruation, certain questions are to be raised. Do women with a slight psychoneurotic tendency have this tendency greatly exaggerated during the menstrual cycle? If kleptomania accompanies menstruation in some (rare) cases, does it do so only in neurotic individuals? Could kleptomania be accounted for by the general nervous tension and instability which is likely to appear at this time? Is menstruation itself a causal factor, or does it merely exaggerate an already existing condition? Does female periodicity play a primary role, or is it merely an exciting (secondary) factor, resulting from the general somatic and psychic disturbances incidental to the menstrual cycle? An extensive search for an answer to these questions did not bring wholly satisfactory results; the author was not able to discover any substantial amount of published materials, either medical or psychological, upon the problem per se. Perhaps the most pertinent data of a specific nature are contributed by Burt, who finds in a small group of analyzed cases that theft is one of the common forms of delinquency among neurotic women during the menstrual cycle. He writes:
“Theft?more often theft from impulse and opportunity than enterprises calmly planned?is the commonest offense occurring during these days; at such times, and at no other, many young women of a neurotic and unstable disposition take to shoplifting and to larceny of that seemingly motiveless kind which the popular journalist styles kleptomania. In some, however, a fuller study will disclose that the robberies are not exclusively confined to those occasions, but that they are then performed with greater carelessness and so found out with greater ease.’’1 i C. L. Burt, The Young Delinquent. New York, D. Appleton and Company, 1925, p. 216. The author should not fail to mention that data of a less specific nature have been contributed by Stekel, who is of the opinion that “it is an open question whether any impulsive acts are other than sexual. I mean that in every instance a connection with sexuality is traceable. Many of the older writers, belonging to the preanalytic period, have pointed out that women yield to the kleptomaniac tendency mostly during the menstrual period, or while pregnant. … We know that the female organism is sexualized during menstruation as well as during pregnancy” (W. Stekel, Peculiarities of Behavior. New York, Boni and Liveriglit, 1924, p. 259). Stekel offers a detailed account In a footnote, Burt adds:
“In eighteen young girls, age fourteen to nineteen, kept under observation for six to seventeen months and selected because of the frequency of their misdeeds, I found that, of the total number of demonstrable thefts (amounting in the aggregate to eighty-seven), as many as 34 per cent occurred during what may be termed the menstrual week; and, on the average, only 22 per cent during each of the other three weeks. In three of these cases more than half the thefts were committed during the seven days in question; in five other cases, taken from a longer list of 200 girl delinquents, more than three-quarters; in two, there seemed an approach to a fortnightly rhythm, with an interposed disturbance perhaps connected with the so-called Mittel-Schmerz. I can find but two instances in which stealing never occurred except during these short spells of stress.’’2
From the foregoing data it would appear that menstruation is a factor of some importance in cases of kleptomania among neurotic females. Burt is, however, inclined to attach less significance to the actual period of indisposition than to what may be called the premenstrual phase.2 “In the premonitory stages,” he points out, “the dominating mood is one of excitement rather than depression. Among unstable persons instability is then often at its highest; …” 4 Not being completely satisfied with what the literature contained relative to a possible relation between kleptomania and female periodicity, the author prepared a questionnaire-letter to be sent to a representative number of specialists in nervous and mental of one patient, who, at the time of committing a larceny, was menstruating “and shortly thereafter she fell into a severe depression” (Itidp. 272). Wagner-Jauregg also stresses the point that kleptomania occurs among women more frequently during the menstrual period. Laqueur believes that kleptomania has an organic background; he concludes that among store kleptomaniacs the tendency to steal is an actual sexual toxicosis. He finds that relatively healthy-minded women may pass through occasional periods of giddiness during menstruation, at which time they may commit acts of theft which must be considered morbid.
2 Loc. cit.
3 In some menstruating women the “premenstrual tension” (a term originally coined by Frank) is characterized by a syndrome of marked nervous, vascular instability. Mazer and Goldstein (Clinical Endocrinology of the Female, p. 167) give a brief, but accurate, description of this premenstrual condition. 4 Op. cit., p. 216. diseases in the cities of Chicago, Cleveland, St. Louis, Cincinnati, and Indianapolis.5 This form-letter was mailed to one hundred specialists (practitioners and medical school professors) in neuropsychiatry and psychiatry, their names being carefully selected from the Twelfth Edition (1931) of the American Medical Directory. In response to the one hundred questionnaire-letters which were sent out, forty-three answers were received and eight letters were returned unclaimed because of “insufficient address.” The distribution, by cities, of the number of questionnaires sent and the number of answers received appears below:
No. of A’s City No. of Q’b Sent Received Chicago 42 18 Cleveland 15 8 St. Louis 22 8 Cincinnati 11 4 Indianapolis 10 5
The letter, to which these neuro-psychiatrists and psychiatrists were invited to respond, need not be reproduced here. It merely made a brief allusion to the case of the patient cited previously6 and asked the specialists to express their opinions, based either on clinical observation or on mere theoretical judgment, with reference to the relation, if any, between kleptomania and female periodicity.
No attempt will be made here to classify the questionnaire answers, because most of them lack the specificity that is required for classificatory treatment. In general, however, the first twelve replies, appearing below, lean toward, or are somewhat in sympathy with, an affirmative answer to the question, “Do you believe that menstruation is causal in any way?” while the last twelve replies lean toward, or are rather in sympathy with, a negative answer. Only a few of the most pertinent extracts concerning the major interest of this present inquiry will be quoted. Chicago (NP):7 We have as yet insufficient fundamental in5 These cities were selected because of their proximity to the author. Nothing, of course, could be gained in a study of this kind by selecting specialists on a geographical basis.
e It is to be regretted that a more detailed account of the case could not be given. Experience has repeatedly demonstrated, however, that questionnaires must be very much to the point, if answers are to be elicited. This is indeed, the chief weakness of the questionnaire as a method of securing scientific data.
7 Whenever the letters NP are used, this is to indicate that the physician limits his practice to, or is especially interested in, Neurology and Psychiatry. formation concerning the causal relations between the endocrines and psycho-pathological phenomena to permit expression of opinion. However, clinically it is my impression that the causal relation between menstruation and kleptomania is similar to that which we occasionally see in other neuro-psychic entities; particularly that of epilepsy … I believe that in this class of cases the menstrual crisis is an exciting etiological factor of the cerebral crisis. The cerebral crisis may consist of an epileptic seizure (most frequent) or of an attack of Kleptomania, etc. However, these crises occur only in individuals who are predisposed (whatever that may mean) to these crises.
Theoretically, I assume that there is a causal connection between the vascular nervous irritation that produces concomitantly the menstrual epoch and that of the cerebral crisis.
Chicago (NP): Replying to your inquiry of the relation, if any, between female periodicity and conduct disorder, my psychiatric experience warrants these data… . Case 2. Girl 16, periodically stole simply and without cunning or cover-up. Also periodically cheated in class obviously. Medical history showed menstrual irregularity, maybe two or three periods a year. Examination revealed Frohlich’s disease of hypogenitalis-hyperadiposity. Study showed that her conduct disorder occurred only when she should have menstruated and did not.
Treatment was pituitary and ovarian therapy. When menstruation became regular every month, conduct became ideal. B.A. and Phi Beta Kappa in three and one-half years.
Chicago (NP) : I have had no cases where kleptomania occurred during the menstrual period. I believe, however, that such cases may occur in neurotic individuals and could be explained on a sexual basis if carefully psychoanalyzed.
Chicago (NP) : I know of several cases where young girls in an institution for delinquents stole, the episodes occurring at a time corresponding to the menstrual cycle. Since we observed them over a period of time and found no evidence of stealing at other times, we were inclined to believe that there was a definite Likewise, when the single letter P is used, this is to indicate that the physician limits his practice to, or is especially interested in, Psychiatry. These data were taken from the Twelfth Edition (1931) of the American Medical Directory, which is a register of legally qualified physicians in the United States. This information concerning specialists is based on personal data furnished by the physicians themselves and is not, therefore, verifiable. connection, particularly so in one case I remember where the girl ?was assaultive at the occurrence of the period. In our clinic we see a number of cases where menstruation and problem behavior are linked up with endocrine treatment, implying that the menstrual difficulty is in all probability the cause. Chicago (NP) : Repeated clinical observation has resulted in most neuro-psychiatrists holding the opinion that kleptomanic episodes are most frequent at the menstrual period.
It would seem that it expresses an increased eroticism; as, for example, does the panicky exacerbation, seen in an anxiety neurosis, at the menses. The anti-social act of stealing therefore becomes the symbol for the anti-social sexual indulgence, which craving is beating more wildly against the censorship of the primary (usually dominating) personality because of the (cyclic) ovarian stimulation. Other mechanisms must not be disregarded: an urge to steal {per se) or an expression of social hate flaming up under increasing need of emotional frustration or lessened emotional control. The ovarian cycle modifies somatic and psychic tensions and becomes one root in that maze of conscious and unconscious feeling tones which finally find partial expression in what we call behavior. Cleveland (P) : My own feeling in the matter is that the menstrual period does not lessen self-control, or at least that that is not the chief element in this, but that, because of the tensions in the sex organs at this time, there is much more likely to occur an outbreak of the compulsive disorder, stealing in this instance, which I think you will find has as a motivating factor a disturbance in the sex field. In other words, menstruation is causal in that there is a much greater autonomic tension, which, in turn, permits the unconscious sex conflict to produce symptoms. Chicago (NP) : At the menstruation period a neurotic girl is usually upset nervously and has not the usual self-control; this will account for her waywardness, be it kleptomania or any other form of misbehavior. Pregnancy has been known to have the same effect. A normal girl or woman would not be affected that way. It is not the female periodicity as much as the mental instability… . St. Louis (NP) : After observing some insane suffering from an aggravation of their condition only at the menstrual period, I thought it evidence per se that the monthly function was the sole basis of their disturbance. The history of these patients disclosed no disturbance or noisy manifestations except at the appearance of the menses.
If the libido is dominant in some women only at this time, why could not your subject’s morbidity be present only at her periods? In my opinion I do not hesitate in stating that this unfortunate girl is a kleptomaniac with her menstruation, and all its unknown and unsolved physiology is the causative factor.
St. Louis (P) : I do not find that I have records of such cases or in fact that I have had such cases at all recently.
I consider it possible, however, that emotional reactions, accompanying the periods, might have the effect of suppressing normal inhibitions and allowing a tendency to compulsive acts to become effective.
Cleveland (P) : … If we think of Kleptomania as a part of a Compulsion Neurosis, we must recognize the surge or cyclical tendency in the severity of symptoms. In a neurotic woman there is always an increase in instability associated with the menstrual cycle, and we might expect an intensification of compulsive urges coincidental with it. In general, it would be expected that this might begin a few days before the period. When the menstrual flow is well established this heightened irritability usually ceases. It must be borne in mind that the period of increased instability lasts perhaps in all about a week, and therefore in a woman in the child bearing period it represents about one-fourth of her life. So, naturally, there is a 25 per cent chance that any type of occurrence would fall within that period. Menopause and jeven pregnancy are occasionally found in our cases and alleged by the defendants and attorneys as causative factors. Before we complete our investigation, however, these factors usually fade in significance in the light of other conditions.
Undoubtedly, the endocrine factor, as well as the neurotic, should be considered in all cases where it appears to have a bearing, but I think on the whole their influence as causal determinants can easily be exaggerated.
Cleveland (P) : In no cases of Kleptomania that I have studied has there appeared to be any definitely causal connection. I should think that for any special condition to motivate compulsive behavior, it would necessarily depend upon some special significance of the state to the individual. To establish such a connection would require more than a chronological sequence or coincidental occurrence. Since any situation may serve either directly or associatively to precipitate anxiety phobias, obsessions and compulsions, there is no reason that I can see why the menstrual period might not serve the same purpose and might be causal in this sense. I doubt very much that such behavior will ever be reducible to a single principle or that any fundamental or absolute cause will ever be established for it. Cincinnati (NP) : As sexual excitement is frequently greatest at the menstrual period it is not unlikely that there is some association between the two conditions. My own opinion is that there is a relationship in some specific instances.
Indianapolis (P) : I have not been able to observe any definite causal connection between kleptomaniacal tendencies and the menstrual period. In cases where such observations are made I believe that the menstrual epoch merely exaggerates an already existing condition. “We see this so frequently in many types of psychoses with a pronounced neurotic personality, especially with a marked unstable hereditary predisposition… . Any equally pronounced exciting factor from other causes would produce the same reaction in an individual of an unstable nervous organization. I recall several cases of kleptomania that did not develop until after the menopause.
Cincinnati (P) : … I will say that we have had quite a number of cases of kleptomania, but we have no record in our own experiences of these individuals being associated with female menstrual periodicity. In fact, we have had two patients whose kleptomania began at the involutional period, and there was no history of a kleptomania until secession of the menses.
St. Louis (NP) : … It is my opinion that there is no specific relation between kleptomania and menstruation. As I see it, kleptomania is a complex that develops in mental abnormality, psychopathy or deficiency and is different from any other complex only in its strength and resistance to influence. If kleptomania happens to appear near or at the time of menstruation, I should think that the fact is accounted for by the general nervous instability and tension which is likely to appear at this time. Usually nervous symptoms of any type are then magnified. St. Louis (NP) : If only females were kleptomaniacs, if they were more often so than males, and if only females were ‘’ unstable and neurotic,” then one might reasonably infer some relation between kleptomania and menstruation. Therefore, I would answer the query?”Do yon believe that menstruation is causal in any way?”?no. My belief, however, is based upon my experience. St. Louis (NP) : In reviewing cases from memory I can recall no special association. Kleptomania has occurred in a few patients, both male and female, before puberty. By this I mean a desire by children to take what does not belong to them, which is definitely pathological and far beyond that seen in what may be considered the normal. It is quite possible that I have been overlooking the association of the menstrual crisis and kleptomania in my patients. Chicago (NP) : … I will say that I do not subscribe to the belief that menstruation per se has a direct bearing on uncontrollable compulsive acts, such as kleptomania. … It seems to me that there must be some unconscious driving, motivating impulse during the pre- or menstrual period, which, by repetition, has become habitual and the cause or causes for which could probably be unearthed by psychoanalysis in a wider sense. Deep analysis would undoubtedly furnish the clue to this moral dereliction.
Cincinnati (NP) : I have had one case of kleptomania in a woman whom I treated by Psychoanalysis. In this case there was no relation shown between kleptomania and the menses. This patient had had a total hysterectomy. She had the kleptomania before and for a number of years after the operation. I do not be-, lieve that menstruation is a cause of kleptomania.
Cleveland (NP): I have extensive notes on 26 cases of alleged kleptomania and doubt very much if the menstrual epoch had any etiological connection. Fully one third of my patients were seen prior to the age of 30, and in scrutinizing their psychic reactions I invariably found that they not only were loose-fingered during early years but entertained an un-moral slant on life. Those who were older exhibited hysteric stigmata at one time or another. One lady, age 46, displayed kleptomanic tendencies for the first time while passing through the menopause. … In this case involutional changes may possibly have operated as a contributing factor. Indianapolis (NP) : I have not connected menstruation with any criminal tendencies in girls or women. In fact, my observation has been, if a girl is normal, and her time taken up with an interesting occupation, the nervous phenomenon, usually attributed to that period does not occur, and I would say that menstruation is not causal in any way.
Cleveland (P) : I fail to see how it could have any effect, as kleptomania is as common in male as female. Again, our physioloKLEPTOMANIA AND FEMALE PERIODICITY 241 gists teach us that the menstrual cycle is a purely physiological phenomenon.
Kleptomania is an interesting study and must have much significance regarding psychiatry. It seems to me we have proved little regarding the menstrual crisis. One reason, we have lacked a normal control. I am hoping our women’s colleges will give us more information regarding their type of women, as it will vary very much from the factory women.
Indianapolis (NP) : In the limited number of cases that have come to my attention, I would say that I am led to believe that it is no more common in the female than in the male, and that I do not feel that menstruation is causal in the female in any way. St. Louis (NP) : I have not any evidence to indicate any uniform relationship between compulsive stealing and the menstrual period. … I would feel that disturbance incidental to the menstrual period could be a predisposing factor. I do not believe that it would play a more definite causal role.
Certain interesting trends of opinion are to be noted from the replies that were received. First and foremost, the author was impressed by the fact that the majority of the respondents stated that they had very little, if any, clinical data with which to answer the question. Many said that they had not observed any cases in which kleptomania was associated with the menstrual cycle, and that they could not, therefore, express a valuable opinion. It was evident that many of the respondents hesitated to commit themselves except in a rather general way. The problem, in fact, seemed to be somewhat novel to several of the respondents, a few of whom not only thanked the author for calling their attention to the case in question, but stated that in the future they would attempt to determine any association between kleptomania and female periodicity that might be of value. A chairman of a Medical School Department of Neuro-psychiatry writes: “I believe your proposed investigation is well worth-while, even though it should turn out to be wholly negative, and that the elucidation of the point would be of value.” It is furthermore evident from the questionnaire replies that kleptomania is an exceedingly rare disorder. Several respondents commented upon the paucity of the literature dealing with the problem of kleptomania, and regretted that they had such a small amount of case material of their own to submit. The following excerpts are quoted, respectively, from the letters of a practicing psychiatrist, a superintendent of a hospital for nervous diseases, a director of an institute for juvenile research, and a head of a psychiatric clinic: “I have not had a patient of either sex under my observation who was afflicted with kleptomania.”
“I do not find that I have records of such cases or in fact that I have had such cases at all recently.”
“I have seen no case that I would consider kleptomania in considerable experience, particularly with delinquent boys and girls.” “I believe that true or pure Kleptomania like Dipsomania or even Paranoia, is more an ideal concept than a common condition, and that what we see in practice are cases which merely resemble those pure types.”
The questionnaire returns also bear out the assertion, made previously, that kleptomania, as a clinical entity, is, in many instances, neither well defined nor adequately diagnosed. One respondent, a director of a psychiatric clinic in connection with a Court of Common Pleas, makes the following pertinent comment with reference to the definition of kleptomania:
“Kleptomania is defined as ‘an irresistible impulse to steal,’ and is usually conceived to be a symptom of Compulsion Neurosis or Psycliasthenia, in which event it should be accompanied by other neurotic symptoms.
“When we speak of ‘irresistible impulse’ we must always bear in mind that much of our crime is somewhat impulsive (that is, lacking much premeditation), and that probably most of it is purposeless, at least to the extent that the perpetrator receives no lasting benefit from his act. Whether the impulse is irresistible or unresisted is usually a matter of degree.” Another specialist, connected with an institute for juvenile research, says: “The apparently aimless stealing usually has a background of some sort which may be cryptic or may be obvious, if one understands the background. It would be my impression that one would have to study thoroughly the motives of stealing, the relationship of the article stolen and where stolen to the girl’s background, wishes and interest before establishing definitely the idea of kleptomania.” A medical director of a hospital for nervous diseases asserts that he does not believe that the writer would be justified in making a diagnosis of kleptomania. “I regard it,” he says, “merely as a symptom of profound psychosis.”
Although the respondents supplied the writer with very little ease material relative to a possible connection between kleptomania and the menstrual function, it is, nevertheless, instructive to note that several of them made reference (from clinical records) to the relation between kleptomania and other somatic and psychic conditions. For instance, several physicians mention the apparently oft-observed connection between kleptomania and epilepsy. A former State alienist writes: “I have a patient under observation for the last two years, a young woman of 20, who has epileptic attacks just before or during her menstrual period and at no other time.” A neuro-psychiatrist reports: “I have opportunity to see fairly often patients of epilepsy whose attacks occur only during menstruation or a couple of days before or after the menstrual periods.”
Other respondents mention the relation between kleptomania and certain psychotic conditions in females. It is a well-established fact, of course, that many psychotic women manifest exaggerated symptoms during their menstrual periods. One psychiatrist refers to the Manic-Depressive and Schizophrenic groups as occasionally exhibiting violent mental disturbances just before or during the menstrual period. Another writes, “Manic-Depressive females show, not infrequently, a marked exacerbation of symptoms at or about menstruation time.”
A superintendent of a State Hospital cites the very interesting case of a pyromaniac, who, with each menstrual period, could not resist the morbid impulse to set fire to her house. This case recognized the pathological character of her impulse and requested to be removed from the home at this time, as she had two children that she thought might be burned during the fire.
One respondent also calls attention to a few recent reports pertaining to the relationship between kleptomania and sexual excitation (kleptolagnia), in which it has been pointed out that kleptomania is coincident with sexual excitement accompanied by an orgasm. Most students of this phase of abnormal psychology are, to be sure, familiar with the opinion, which has often been expressed, that kleptomaniac acts are analogous to sex acts. One physician mentions “kleptomania as a masturbation substitute, sometimes sadistic kleptomania.” Also, the type of morbid compulsion (in both males and females) associated with fetichism is referred to by several. All of these viewpoints are too well known to receive more than passing mention here.
A few of the questionnaire replies bring into the open another important consideration which merits emphasis?namely, the tendency of some women, either consciously or unconsciously, to use menstruation as an excuse for kleptomaniac acts. One specialist well states this point:
‘’ I have noted the tendency in many women to connect all sorts of difficulties, mental as well as physical, with their menstrual periods. Many of them seem to expect in advance that abnormalities are likely to show at the menstrual period. If some difficulty does develop coincidental with the menstrual period, the very natural tendency may be to expect the same kind of difficulty to develop later, at other menstrual periods. I think that a patient subject to kleptomaniac attacks might unconsciously save or store up the energy resulting in kleptomaniac tension and be convinced that relief by kleptomaniac acts at the time of menstrual periods had more justification than at other times.
‘’ The possibility that I am trying to point out is this: that the stresses of the menstrual period by themselves could not adequately explain the kleptomaniac acts; but that the knowledge possessed by the subject that abnormal experiences and reactions can accompany menstruation might lead to a concentration of kleptomaniac acts at the time of the periods. In this way a patient would secure relief of tension by performing the act and at the same time have an excuse for so doing. Naturally, the process might very well be an unconscious one.”
Another respondent writes: “What experience I have had, which is not much, leads me to believe that kleptomania is in part a lesser crime committed to distract attention from a greater crime. As one young woman said at the end of a fifteen minute reply to my question, ‘Why did you steal?’, ‘… and when my sister was 15 she had a baby and I’d do anything rather than that.’ Apparently to put oneself in the position of deserving punishment seems to be one of the ways of resisting temptation, as if one might say, ‘I have been bad, I must pay for it,’ and to seek pleasure is not punishment primarily. ‘’ In view of this attitude it is natural that temptation should be greater sometime around the menstrual period. This is the only causal connection that I at present can see.”
It is clear from the replies that a majority of the respondents are somewhat sympathetic with the belief that the widespread somatic and psychic effects8 of the menses may act as exciting factors in producing kleptomania or other compulsive acts in neurotic females. Apropos of the physical and mental effects of the menstrual function upon an unstable constitution, three physicians write: “At the menstruation period a neurotic girl is usually upset nervously and has not the usual self-control.”
“We see numerous instances of psychoneurotic and psychotic symptoms occurring during the menstrual period… . Women with a psychopathic tendency seem to have this tendency exaggerated during the menstrual period.’’ “So protean is the alteration of the female character, either somatic or psychic, at this time that I think it is an exceptional one who is free of all symptoms.”
It is a well-established fact, of course, that in some women, especially the unstable and neurotic, loss of self-control, or even marked mental abberrations, may appear during the monthly period.9 To quote Burt:
“The pain, the discomfort, the bodily lassitude, with some for the time being quite acute, must tend, like every other derangement in the sense of bodily well-being, to augment irritability and to lessen self-control. … In my small group of analyzed cases I found that the psychic disturbances connected with menstruation appeared as a factor in delinquency among about 4 per cent of the girls.”10
A state of confusion, which may or may not be accompanied by compulsive acts, often occurs in some women during menstruation.11 It is, moreover, common knowledge that, during menstruation, signs of Weltschmerz, low spirits, irritability, restlessness, excitability, and even hysteria may be observed in neurotic individuals. Finally, it is evident from the questionnaire replies that kleptomania is to be viewed as having a background of instability, the diss Perhaps one of the best of several treatments of the mental reactions accompanying female periodicity is Chadwick’s Psychological Effects of Menstruation (Nervous and Mental Disease Publishing Company), which contains some significant data relative to certain pathological psychic manifestations appearing during the menses.
9 This point hardly needs any discussion, inasmuch as it is a commonly accepted fact that during the menses there is an imbalance of the vegetative nervous system, which is evidenced by many clinical manifestations. Op. cit., pp. 215 f. ii Cf., E. Bleuler, Textbook of Psychiatry (Trans, by A. A. Brill). New York, The Macmillan Company, 1930, p. 210. 246 THE PSYCHOLOGICAL CLINIC order appearing rarely, if ever, except in psychoneurotic persons. It perhaps never occurs where there is (to use an old phrase) mens sana in corpore sano. If, indeed, kleptomania is to be conceived as a symptom 12 of Psychasthenia or Compulsion Neurosis (as is traditionally the case), it might be expected that it would be accompanied by other neurotic symptoms and that it would exhibit a history of instability. This point is made especially clear in many of the questionnaire statements, a few of which have been quoted previously. Kleptomania, appearing near or at the time of menstruation, can be accounted for, says one specialist, “by the general nervous instability and tension which is likely to appear at this time.” A superintendent of a State Hospital believes that “the menstrual epoch merely exaggerates an already existing condition.” “Any equally pronounced exciting factor from other causes,” he adds, “would produce the same reaction in an individual of an unstable nervous organization.” “There is no relation between kleptomania and the menstrual cycle,” writes a neuro-psychiatrist, “except that a woman is less stable at this time.” Another specialist writes that, as a cause of kleptomania, “it is not the female periodicity as much as the mental instability, which is usually congenital and hereditary.” “Kleptomania does not develop in just any individual,” remarks one respondent, “but in those in whom the way has been prepared by earlier difficulties and failures of adjustment. It is just such persons who could unconsciously seize upon excuses for the acts that they perform.” Another comments: “That there is a relationship between kleptomania and female periodicity in certain cases can hardly be denied as I have seen the condition occur, in some cases, only during the prodromes of, and the menstrual period. In other cases there seems to be no connection whatever. I feel that the influence of the period is simply to lower the general resistance in a substandard individual.” In summary, it may be concluded that a majority of the specialists seem to suggest, either by direct statement or by inference, that, although kleptomania may occasionally accompany menstruation, the compulsive disorder occurs only in neurotic individuals. Menstruation, moreover, does not appear to play a primary causal role; nevertheless, the general somatic and psychic disturbances incidental to periodic functioning may act as an exciting or sec12 The point can not be stressed too much that kleptomania is the name of a symptom, or rather, of a symptom complex, and it can not be considered as a definite mental disease.
ondary factor. Kleptomania would, in this sense, find facilitated expression during the premenstrual and menstrual periods, when emotional stability and tension are greatly altered. In other words, kleptomania (or perhaps other compulsive acts) may result when menstruation, as an exciting factor, is superimposed upon an already existing neurotic (or psychotic) condition. As one psychiatrist, quoted previously, pertinently remarks: “Since any situation may serve either directly or associatively to precipitate anxiety phobias, obsessions and compulsions, there is no reason … why the menstrual period might not serve the same purpose and might be causal in this sense.”
Although there is at present, let it be admitted, no final answer to the question raised in this discussion, the problem is surely of sufficient importance to merit a careful study of those clinicians who deal mainly with conduct disorders.
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