Mental disorder

“ We have long known that we have to do with a definite organ, the brain; but only beyond the brain, beyond the morphological basis do we reach what is important for us—the mind; as indefinable as it ever was, still eluding any explanation, no matter how ingenious. Former ages, endowing the mind with substance, and personifying every incomprehensible occurrence in nature, regarded mental disorder as the work of evil spirits; the patient was looked upon as one possessed, and the methods of treatment were such as fitted this conception. ”

“ One became especially convinced of the potency of mental factors in the production of mental disease from the observation and study of the psychoses of criminals. Here the conflicts which lead an individual to seek in mental disorder a satisfactory compromise are so concrete as to leave no doubt concerning cause and effect. ”

“ Those who still believe in an exclusively materialistic theory of mental disorder must find it extremely difficult to maintain their doctrine in the face of the many incontrovertible facts brought to light through modern research in the field of psychopathology. ”

“ One need not enter into a lengthy discussion in order to show that we have here a mental disorder, the origin of which can be definitely traced to psychic causes, the emotional shock accompanying the crime and conviction. ”

“ We have seen the mental disorder affecting modern society manifesting itself chiefly in the following forms: Mysticism, which is the expression of the inaptitude for attention, for clear thought and control of the emotions, and has for its cause the weakness of the higher cerebral centres; Ego-mania, which is an effect of faulty transmission by the sensory nerves, of obtuseness in the centres of perception, of aberration of instincts from a craving for sufficiently strong impressions, and of the great predominance of organic sensations over representative consciousness ”

“ Since one of these has possession of our consciousness, or is at least predominant at every point of time, whichever function of the mind happens to be that which is falling into disorder, by it the form of insanity is determined. ”

“ What further illumination concerning the mental processes of an individual can be desired than is conveyed in the statement that he is a manic-depressive personality, or that he displayed the manifestations of the mental disorder known as the manic-depressive psychosis? ”

“ Mental life, after all, expresses itself in a series of reactions destined to result in a proper adaptation to environmental conditions, and the causes which determine a given reaction may be psychic as well as physical in nature. Indeed, in the realm of psychopathology we see indubitable evidence of the predominance of psychic causes of mental disorder over physical ones, and the subject under discussion here further emphasizes this. ”

“ The type of behavior disorder, the social reactions, the trends of interests, etc., which psychopathic personalities may show give special features to many cases, e.g., criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities. ”

“ Turn now to the psychology of the abnormal mind. Here we find, under the heading of individual psychology, (8) the psychology of deficient and exceptional minds; of blind deaf-mutism, of genius, of the subnormal and the supernormal child; (9) the psychology of temporary mental derangement; of dream, of hypnosis, of intoxications, of occasional hallucination and illusion; and (10) the psychology of permanent mental disorder, of the chronic derangements of insanity. ”

“ Images taken for real things are common in some forms of mental disorder. Here the subject's hold on objective fact is weakened by his absorption in his own desires and fears, and he hears reviling voices and smells suspicious {376} odors or sees visions that are in line with his desires and fears. ”

“ On the other hand, the development of a mental disorder such as posttraumatic stress disorder, which can last months or even years, or even chronic depression, which can also last for a considerable period of time is untreated, might satisfy the prolonged hard requirement. ”

“ Speaker, October 3-9 is Mental Illness Awareness Week. During any one-year period, up to 50 million Americans--more than 22 percent--suffer from a clearly diagnosable mental disorder involving a degree of incapacity that interferes with employment, attendance at school or daily life. Like so many disorders, mental illness does not discriminate and affects every age, ethnic, and socioeconomic group. ”

“ When the mind undergoes degeneration, the moral feeling is the first to show it, as it is the last to be restored when the disorder passes away; the latest and highest gain of mental evolution, it is the first to witness by its impairment to mental dissolution.... ”

“ At the outset we shall endeavor to draw a distinction between the class of individuals we have just discussed, and that which we are about to consider now. We have seen that the former is made up of individuals who in most instances have come in conflict with the law for the first time, and that the mental disorder which they develop stands in the closest relation with some definite experience in their life. ”

“ The effort to work becomes daily more laborious, the task of fixing the attention grows increasingly difficult, thoughts wander, memory fails, the reasoning power is enfeebled; prejudice—the shade of defunct emotion or some past persuasion—takes the place of judgment; physical nerve or brain disturbance may supervene, and the crash will then come suddenly, unexpected by on-lookers, perhaps unperceived by the sufferer himself. This is the history of "worry," or disorder produced by mental disquietude and distraction, occasionally by physical disease. ”

“ While we now know that more than one in five Americans experiences some form of mental illness each year, that many mental disorders are biological, and that they can be treated medically, too many people still believe that mental illness is a personal failure. ”

“ Though there is no unanimity about this among health care professionals, we will distinguish between these two kinds of problems by calling a psychosis a mental illness, as opposed to an emotional disorder. It is a matter not only of degree but of kind. A person who is severely depressed or extremely anxious is usually still able to communicate rationally, and distinguish what is real from what is fantasy or delusion. ”

“ But after all, a large number of people whose mental processes are not normal, have only themselves, their poor emotions, their lazy wills, their hazy thinking to blame. We except what are called the heredity insanities—dementia præcox and the other dementias and the manic-depressive groups and paranoia and psychasthenia—for in these cases, possibly with the exception of the manic depressives, even the most perfect environment could probably not prevent the disorder from asserting itself. ”

“ A world of trouble would be saved if, in all mental derangements, apart from brain-disease, persons who feel things going amiss with them (and I am convinced this premonition of mind-disorder is a common experience) , whether the sensation be one of “irritability” or of “confusion,” would undertake of their own free motive, to cure the evil by subjecting the consciousness to a regular course of training. The best plan is to set the mind a daily task of reading, not too long, but sufficiently difficult to give the thoughts full employment while they are engaged. ”

“ Once shrouded in mystery—and spoken of only in sad, hushed tones—mental illness is becoming more widely understood. Thanks to dramatic advances in basic biomedical research and in the behavioral sciences, we have been able to achieve significant improvements in the diagnosis, treatment, and prevention of emotional and mental disorders. Scientific progress has also helped to alleviate the stigma associated with mental illness, as more and more Americans learn about its origins and effects. ”

“ Naturally, these psychoses, being, as they are, psychologically motived, are extremely variable in their manifestations, but at the root they are all alike and impress the observer as something entirely different from the pure endogenous mental disorders. ”

“ Mental disorders were moral and legal problems rather than biological, social, and medical problems. Their genesis was wholly misunderstood, and legal, medical, social, religious, and philosophic prejudices went far toward preventing any rational scientific mode of approach to the questions involved or any formulation of investigative procedures that promised to be fruitful. Even to-day the same prejudices are all too inhibitory ”

“ Nevertheless, it is a fact that there are real mental disorders in the world, and innumerable honest and earnest people who have something the matter with them which they do not understand. Here is one way by which the conscientious investigator can find out what the trouble is, and make it clear to them, and by establishing harmony between their conscious and their subconscious minds, can many times put them in the way of health and happiness. ”

“ After studying in each patient all the non-mental disorders such as infections, intoxications, and the like, we can now also attack the problems of life which can be understood only in terms of plain and intelligible human relations and activities, and thus we have learned to meet on concrete ground the real essence of mind and soul—the plain and intelligible human activities and relations to self and others. ”

“ Reality is the normal direction for the libido and because the direction is normal they more readily result in recovery." [421]
The American Psychiatric Association, in its manual designed for the assistance of hospitals for mental diseases in the compilation of statistical data, makes the following suggestions as to the delimitation of the manic-depressive psychoses:—
"This group comprises the essentially benign affective psychoses, mental disorders which fundamentally are marked by emotional oscillations and a tendency to recurrence. ”

“ Some cases terminate in a chronic condition which may improve somewhat in time. There may be a persistent emotional and mental enfeeblement with indifference, loss of memory, lack of judgment and impairment of will. ”

“ If this is the case with those suffering only from mental deficiency, it is evidently more likely to occur in those suffering from any form of mental disease, which is often liable to change its character, and to pass from the form of depression to one of excitement. ”

“ Even in the lighter forms of psychic degenerative forms that lie on the borderland of mental alienation, such, for instance, as are present in the various forms of psychopathic maladies we still find that the same relation holds good. ”

“ The events of the last hundred years include more particularly the delimitation and complete differentiation of general paresis, the rise and fall of the paranoia concept, the description of the traumatic psychoses, the establishment of the alcoholic insanities as clinical entities, a study of the mental diseases due to endogenous and exogenous toxins, the recognition of the neuroses and psychoneuroses in their modern sense, the addition of the psychopathic personalities to our classification and the definition of manic-depressive insanity, dementia praecox and involutional melancholia. ”

“ But perhaps we have not sufficiently indicated a diseased state of consciousness, from which most intellectual men have suffered, many have died, and all should be warned,--the disease, namely, of mental disgust, the sign and the result of mental debility. ”

“ CAUSATION.—It is clear that only a small proportion of the human race is liable to become insane, and one can only wonder that so few brains are overthrown by the multiplicity of causes in modern life which tend to disturb those “invisible thoroughfares of the mind which are the first lurking-places of anguish, mania, and crime.” When we come to investigate the causes of mental disease, we find that they are of two kinds—remote or predisposing and immediate or exciting. ”

“ But the gist of the whole matter is this: in a neurosis, certain forces of the personality—instincts and their accompanying emotions—which ought to work harmoniously, having become tangled up with some erroneous ideas, have lost their power of coöperation and are working at cross purposes, leaving the individual mis-adapted to his environment, the prey of all sorts of mental and physical disturbances. ”

“ There is no new mechanism introduced to produce a mental illness, but a putting out of gear of those common to the race and their disturbance is the result of the action of influences which may befall any one of us, unbearable ideas with which some intense emotional state is intimately associated. ”

“ If these two forces are lacking in the body to any considerable extent, we have sickness and infirmity and accidents of every kind. If they are lacking in the mind, we find every degree of mental deficiency, every variety of insanity. ”

“ However, you are not unknown to me. I have heard you well-spoken of; and I remember that, when you were a student in Paris, you were mentioned with honor by the college, for an able paper read before the open section upon the very subject to [13] which I now propose to direct your attention,—mental disease," he added, after a moment's hesitation.
"A case of insanity?" bluntly asked the doctor.
"Heaven forbid! And yet I must not conceal from you that I fear it."
"Give me some of the symptoms. Insanity in strong development, or aberration of faculties, or hallucination?" ”

“ They develop in an emotional soil definitely related to the hopes and fears of the healthy individual and are to be looked upon as a morbid transformation of perfectly normal mechanisms. In addition to this he speaks of an increased self-consciousness, a natural tendency to resistiveness, an undeveloped type of thinking, psychological compensations for the disappointments of life, evidences of developmental inhibitions, improper habits of thought leading to morbid conceptions, etc. He refers to exaggerated self-consciousness as the fundamental basis of paranoia. ”