There is a large group of persons who, though not necessarily suffering from epileptic, psychotic, or psychoneurotic symptoms, alcoholic or drug addiction, or feeblemindedness in the strict sense of the term, are nevertheless incapable of attaining a satisfactory adjustment to the average environment of civilized society. This group is very heterogeneous, yet there is much evidence, in family and personal histories and in clinical manifestations, to show that the various conditions comprised in it are in some way related to one another and to other neuropathic conditions.

The maladjustment in these cases seems to arise on a basis of inherent anomalies of judgment, temperament, character, moral sense, or sexual make-up. It need hardly be added that both the underlying defect of personality and the social maladjustment vary in degree and that, moreover, not all social maladjustment rests upon constitutional abnormality of the individual.

Whatever the basic anomaly may be in a given case, it is apt to become manifest in childhood or early youth, but becomes greatly accentuated with emancipation from parental control and the assumption of the entire burden of social adjustment and responsibility. Thereupon, sooner or later, the individual comes to the attention of the police, courts of law, health officers, charitable organizations, or other public authorities as criminal, prostitute, vagrant, sanitary menace, or dependent.

In some cases, of a milder sort, more or less satisfactory adjustment is achieved and maintained until a situation arises imposing special stress or new exactions; then the margin of safety is wiped out, and the individual, previously regarded as fairly normal, is found to be not altogether dependable. Thus many, who in ordinary times are able to make ends meet, become objects of charity when overtaken by illness or confronted with unemployment in hard times. Thus also a previously faithful and trusted bank clerk, discouraged by failure to gain advancement and goaded by poverty, yields to temptation and becomes involved in an embezzlement. And thus, again, the World War, with its acid test of demand for great personal sacrifice, suddenly brought to light a "yellow streak" in some men previously thought to be like the rest.

The prevalence of such conditions may be judged from the statistics of the National Army in the World War, which show that of all recruits, mainly between the ages of twenty-one and thirty-one, the local examining boards and the medical officers in training camps rejected 0.55 per 1000 for constitutional psychopathic states. Some more subsequently came to light in men who had been accepted for service.

Not infrequently, though, as already stated, by no means constantly or necessarily, constitutional psychopathic states are combined or complicated with mental deficiency, epileptic, psychotic, or psychoneurotic episodes, alcohol or drug addiction, etc.

The following varieties of constitutional psychopathic states have been distinguished in the classification adopted by the Surgeon General of the Army. It will be understood, of course, that most cases represent combinations of two or more of the various traits distinguished in the classification. (1) Inadequate personality. (2) Paranoid personality. (3) Emotional instability. (4) Criminalism. (5) Pathological lying. (6) Sexual psychopathy. (7) Nomadism. Following are brief descriptions of these several varieties.