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Mental Disease (General)

Bryan Applications, M

The majority of people can be described as sane, but that is not to say that they enjoy perfect mental health. Probably this could be said of only a few, the rest presenting some degree of depreciation, slight in most cases, but in others quite considerable. Insanity thus forms but a portion, and a relatively small one, of the province of mental disease.

In the study of mental diseases it is necessary to bear in mind that there is an organic continuity between body and mind, and this connection means more than merely the part taken by the brain, as mental processes are largely influenced by the general activities and states of the body, and notably by the action of the internal secretions or endocrines (q.v.). Mental disorder may be merely symptomatic of some bodily disorder, of inflammation, tumor, or other disease of the brain, for example, of the action of poisons, such as alcohol or Indian hemp, on the brain, or of general diseases, as in the delirium of fevers. Consumption; heart disease and other disorders may also be attended by mental disturbance of one kind or another.

There is, however, a large amount of mental disease which cannot be connected with any gross or even minute changes in the organs of the body, nor with any kind of poisoning. Another fact to be borne in mind in the study of mental diseases is that the mental life of an individual is continuous; for example, much help in interpreting the delusions of an insane person might be at hand, if it is known, to some extent, what had been the “current” of his normal thought.

Causative role of heredity:

Heredity plays an important part in the causation of mental disease, and especially in the first half of life; in the second half its importance rapidly declines before that of other causes. As regards mental disease which can be classed as insanity, important factors besides heredity are the infection of syphilis, which causes general paralysis of the insane and other mental disorders, and alcohol, which leads to a variety of disorders.

The state of the bodily health and ease or otherwise in obtaining a living are also significant, and especially in the latter half of life; there is evidence that the in a community is relative to the incidence of other diseases, or, in other words, that circumstances such as poverty and bad sanitary conditions, which increase the latter, increase the former also.

Sex is another important factor. To mate with a member of the opposite sex is the natural destiny of a sexually mature individual, and the frustration of this design may occasion mental disorder. The incidence of insanity, it has been pointed out, is considerably greater among the unmarried than it is among the married. In some of these cases mental unfitness will have prevented marriage, but this is only a partial explanation of the difference.

Insanity is also more common among those who have been widowed, so that, besides satisfying the biological claims of sex, the married state may conduce to sanity by helping towards a better general adjustment of the personality to the difficulties of existence.

Insanity is more apt to occur at the great epochs of life, namely, puberty, the menopause or change of life, and the onset of old age. At puberty the body comes under the strong influence of the secretions of the sex glands, while at the menopause this influence is diminished and withdrawn; in either instance there may be some interference with the balance normally maintained between the actions of other internal secretions. The danger at the onset of old age may possibly be due to similar chemical changes, but arterial degeneration, by impairing the nutrition of the brain, is of greater importance.

The main point noted in the classification of mental diseases is a particular causation, special prominence of a certain state of feeling, or of some other symptom, or a usual assemblage of symptoms.

Broadly speaking, there are three classes, namely, neuroses, psychoneuroses and psychoses. In the first are comprised neurasthenia, the chief characteristic of which is that mind and body are easily fatigued; anxiety neurosis, which is a constant state of nervous apprehension; and hypochondriasis. In a mild degree neuroses do not differ much from occasional experiences of a normal individual, and the bodily state has much to do with their causation.

Forms of Psychoneurosis:

The psychoneuroses include hysteria, which may either take the form of conversion hysteria or of anxiety hysteria, and the obsessional or compulsion neurosis. In these disorders the state of the body is of little account as regards causation. The diseases included in these two classes are described under their own headings.

The third class, the psychoses, which are usually described as the mental diseases proper, are those which may lead to conduct as will label the sufferer with insanity (q.v.). Here are included the following types:

(1) Organic changes in the brain:

Mental diseases resulting from general paralysis of the insane (q.v.) and other disorders dependent on syphilis or on arterial disease, tumors or encephalitis, or which follow an apoplectic seizure or an injury to the brain. Such are mainly of the nature of dementia.

(2) Idiocy: (and feeble-mindedness) See: Mental (retarded)..

(3) Toxic psychoses:

That is, disorders due to poisoning, usually chronic poisoning, and especially with alcohol lead, morphine or cocaine; occasionally insanity is due to mercury poisoning. Ordinary alcoholic drunkenness may present definite signs of mental disorder, but in some persons, especially those with a neuropathic inheritance, even small quantities of alcohol may produce a state of wild excitement with delusions and hallucinations, perhaps a suicidal or homicidal tendency, and sometimes gross moral perversion. This state is described as mania a potu, and is usually recovered from in a few days; sometimes, however, it proves fatal.

Some results of chronic alcoholism:

Various kinds of mental disorder may arise from chronic alcoholism, the best known being delirium tremens. In another form hallucinations, commonly of touch and hearing, are the prominent features, and may give rise to delusions. A third form, known as Korsakoff s psychosis or syndrome (after the Russian neurologist, Sergei Horsakoff), is characterized by weak-mindedness, irritability, mental confusion, forgetfulness, especially as regards times and places, along with inflammation of various nerves, causing muscular weakness and wasting, loss of sensation and so on. In still another form there is mental dullness and general inefficiency, then delusions and hallucinations, the patient finally passing into dementia.

(4) Epilepsy:

Insanity may be associated with epilepsy (q.v.).

(5) Dementia praecox:

This form of insanity may be manifested from the age of fifteen onwards, but the tendency is much lessened after the age of forty. This and manic-depressive insanity are the forms of mental disease in which inheritance is paramount in causation. The patient begins to show a lack of interest in his surroundings, and becomes more and more apathetic. The habits are dirty. Memory deteriorates, and there are hallucinations and delusions. In some cases there is great depression, and a strong suicidal tendency, in others well-marked delusions, while in a third type there is a curious muscular rigidity. The patient may stand for hours at a time in a fixed position, and if someone places the head or limbs in a particular position, this position will be maintained. Only about 15 percent of cases recover.

(6) Manic-depressive insanity:

When insanity is marked by violent excitement it is described as mania; marked by painful mental depression it is melancholia. A patient may suffer from one or other of these or from each alternately. Mania may be acute and may come on without warning, or there may be premonitory symptoms, such as sleeplessness, depression and so on. There is intense restlessness of body and mind, hallucinations, delusions, incoherence of speech and sleeplessness. In chronic mania there is restlessness, but also weak-mindedness; there may be outbursts of violence or, on the other hand, fits of melancholia.

In melancholia the patient generally sits in a huddled-up position, showing little tendency to move. There is great depression, which differs from ordinary depression in the intensity of the mental suffering, anxiety or fear, which accompanies it. There are delusions, and these generally refer to faults of which the patient deems himself to have been guilty; sometimes however, the patient imagines that he is suffering from some severe bodily affection. Food may be refused. In some instances the patient is stuporous or only partially conscious, but, on the other hand, there may be restlessness and agitation. There is a special tendency to suicide in melancholia. There is a greater prospect of recovery from manic-depressive than from most other forms of insanity, but there is also a considerable risk of-relapse.

(7) Paranoia:

In this type the chief characteristic is a delusion of persecution, though it may be of grandeur. Delusions occur in other forms of mental disorder, of course, but they are fleeting and change in character. In paranoia the patient clings to his delusion, whatever it maybe; he finds reasons for it and regulates his conduct by it. Such a delusion is said to be systematized. To escape or remove the persecution an attempt at suicide or homicide may be made. Before his condition is recognized, a paranoiac may do much harm by false accusations, or even engaging in litigation.

(8) Confusional insanity:

After influenza or some other debilitating disease, childbirth, or a surgical operation, an excessive fatigue, a person may suffer from great confusion of thought, especially as regards dates and persons, waking up from sleep in a dazed state. In conversation there is a failure to complete sentences. There may be delusions, but generally there is neither excitement nor depression. There is no fever. Proper and liberal feeding is of great importance in treatment, and rest in bed if the case is severe; mild cases, on the other hand, may benefit from going out. Recovery within a year is the rule.

(9) Acute delirious mania:

In some circumstances, such as those mentioned above, as causing confusional insanity, or from auto-intoxication (q.v.), a person may suddenly become intensely restless and excited, with hallucinations which are of a terrifying character. There is usually fever, commonly up to 103° F., but sometimes as high as 106°. Control of the bladder and bowels is lost. There is confusion of thought as to surroundings, and delusions which change in character quickly. The patient is sleepless, Again feeding is of first importance, and sleep must be se secured. The bowels should be freely opened. Early treatment may save life, But the complaint is very dangerous.

(10) Dementia:

A damping-down or loss of all the mental faculties, or dementia, is the outcome of many of the disorders described above, but it may occur as a primary condition, as in senile dementia, though in the earlier stages of this there may be confusion of ideas and delusions. In the latter stages, the patient leads a vegetable existence; there is no volition, and no control of the bladder or bowels. A large amount of mental disease is preventable.

That due to heredity, however, could only be prevented by suitable marriage. The marriage of a person from a tainted stock with one belonging to a sound stock is said to be one of the ways in which a taint is destroyed for subsequent generations, but, whatever the chances of this happening: in a marriage of this kind, it is thoroughly established that if both parties come of neuropathic stock the outlook is very bad for their progeny.

Persons who suffer from alcoholic insanity have also an inherited tendency to mental disease; so that, without discussing the public benefits which might be derived from a general prohibition of the use of alcohol, it can safely be said that any person with a neuropathic inheritance should be a total abstainer.

The modem treatment of syphilis, if effectively carried out, will diminish enormously the incidence of general paralysis of the insane, and of the other mental disorders due to the infection.

Public health measures, by diminishing disease generally, and educational and economic measures which raise the standard of comfort of the poorer classes and lessen the stress of their struggle for existence, will also be beneficial. The stress of living for many persons, whatever their social position, would often be lessened by a more judicious choice of vocation; this applies with special force to those in whom the mental staying power and elasticity have been weakened by inheritance.

Young people often need help in establishing easy social relations with their neighbors and in regulating the conditions of the sexual life.

Advantages of institutional treatment:

Some insane persons can safely be kept at home, but when restraint and skilled nursing are needed the expense; and worry involved usually makes institutional treatment necessary. This has the further advantage, however, that the routine of an institution generally has a tranquilizing effect on a disordered mind. There has been widespread concern regarding the way in which inmates of such institutions are treated, and newspapers still report gross abuses. The first in America to expose political corruption in insane asylums was the Chicago alienist, Shobal Vail Clevenger, whose career has been described in The Don Quixote of Psychiatry (1919). Doubtless increased, vigilance will reduce such abuses to a minimum.

In some forms of insanity, dementia praecox, for example, psychotherapy may prove useful. See: Neurasthenia.. Neurosis..

Mental hygiene:

It is generally recognized that a proper development of the body and sound bodily health depend upon the maintenance of good hygienic conditions, but the fact that there is a need for a careful mental hygiene is not so well appreciated. The influence of bodily on mental health is recognized, of course, and, so far as a healthy mind can be secured by making and keeping the body healthy, much public and personal effort is being directed towards mental hygiene. It is clearly established, however, that much mental disease is purely, or mainly psychical in origin, that is to say, it comes from wrong thinking and is more or less uninfluenced by the state of the bodily health, though, on the other hand, it may cause derangement of the functions of the body.

It may be said that responsible and careful education that is directed towards building up a healthy mind, and certainly when the methods and aims of such instruction are properly directed good hygienic habits are inculcated.

This result is attained more or less when the main object in view is not so much what a child will know as what it will become. The lamentable failure that too often attends years of effort in education does not so much consist in the fact that most of what has been taught is speedily forgotten as that the young person enters upon life without mental or moral interests and with a very inadequate capacity of taking his or her place as a social unit. It has been said of some great public schools that, while their products might be ignorant of a good many things when they left school, they were, however, men of the world. Using this phrase according to its best significance, one finds in this statement a correct appreciation of what the mental hygienist looks for from education.

It is in the nature of things that an individual should be profoundly interested in his own personality, but a good education and training will keep him from being wrapped up in himself. Also it is in the nature of things that an adolescent will be subjected to a strong sexual urge, but a sound training will help to control his importunate impulses and turn them into channels that are expedient.

Mental energy is not inexhaustible, and much harm is due to forgetting this. Over-work may leave wounds in the mental constitution that are not easily healed. Also many people are born with less than the average reserve of mental energy, and it is necessary that this point be kept in view when they choose a vocation. This should not be one that will call for a very large expenditure of mental energy nor one to which much worry is incidental.

Application and treatment:

The types of mental disorders that will be most efficaciously treated by means of frequency therapy will be those which are caused by microbial infection, inflammation, or poisoning and toxification.

Some complete cures will be realized, and there is some hope as regards other types of incurable insanity. The physical problems of a mental case, are much the same as those of “normally” minded persons. Therefore it must follow that during a thorough course of frequency sessions there will be a marked change in the behavior, and this can be taken as an improvement if it accompanies better physical health in general.

To some degree there is reason for dispute as regards what constitutes mental disease. Quite plausible cases might be made against epileptics, homosexuals, the habitually violent, isolationists, racists, and religious fanatics to name just a few that are on borderline as viewed from the standpoint of specific individuals, and their behavior.

If the severity of mental disease is judged by its destructiveness, either to the patient, or to those around him, it follows that such a judgment would be rounded out to include militarism, discrimination, capitalism, and some forms of political extremism. A person may be considered insane because of a delusion which alters his behavior in such a way as to endanger others, such as that of Charles Manson. To some degree then, it might be said that such mental disease is infectious.

If homosexuality is destructive because it is the acting out of a sexual tendency towards non-reproduction, resulting in no children, and a subsequent reduction in population, then it is logical that in an underpopulated society, homosexuality would be insanity, and the converse of this would mean that heterosexuality would be considered insanity in overpopulated societies.

By the same token, if militarism leads to nuclear war, which destroys all life on Earth, then a case may be made that is quite plausible to the effect that militarism is a form of insanity.

If self-destructive tendencies is considered insanity when there are attempts at suicide, then plausible cases might be made in regard environmental crimes.