Psychosis

“ According to materialism, psychosis is a product of neurosis; but according to monism, neither is psychosis a product of neurosis, nor is neurosis a product of psychosis, but neurosis is psychosis. They are identical. What an external observer might perceive as a neurosis of my brain, I should at the same moment be feeling as a [466] psychosis. The neurosis is the outer or objective aspect; the psychosis is the inner or subjective aspect.
It is almost impossible to illustrate this assumption by any physical analogies. ”

“ Thus much being established, no reasonable man can hesitate in believing the relation between neurosis and psychosis to be a constant and concomitant relation, so that the step between this, and regarding it as a causal relation, seems indeed a small one. For, in all matters of physical inquiry, whenever we [Pg 56] have proved a constant relation of concomitancy in a sequence A B, we call A the cause of B; and, therefore, it has been frequently said that the evidence of causation between neurosis and psychosis is recognized causation. ”

“ A well defined type of psychosis which as a rule develops gradually and is characterized by the following symptoms: Impairment of retention (forgetfulness) and general failure of memory more marked for recent experiences; defects in orientation and a general reduction of mental capacity; the attention, concentration and thinking processes are interfered with; there is self-centering of interests, often irritability and stubborn opposition; a tendency to reminiscences and fabrications. Accompanying this deterioration there may occur paranoid trends, depressions, confused states, etc. ”

“ The studies of Meyer, Hoch, Kraepelin, Freud, Jung, Bleuler and many others have shown that in manic-depressive insanity, dementia praecox and various other psychoses we are dealing with very definite constitutional conditions, morbid temperaments, personality defects, etc., which are responsible for the maladjustments leading to the development of psychoses. Financial reverses, domestic difficulties, the death of near relatives, the ordinary hardships and disappointments of life, even ill health, do not as a rule mean the development of a psychosis in the normal, properly balanced individual. ”

“ We shall be able from the very outset to recognize that a disorder, in all appearance slight and which is not deeply set, presents a bad prognosis, and we shall be able to foresee a serious and deep psychosis in the future. ”

“ These are the most difficult, inasmuch as the patient is often so withdrawn and so introverted that at any given interview there may be no objective evidence of mood or ideas. Here the development of the psychosis is often an aid to diagnosis. ”

“ Then fear, with its physiological manifestations, is always an obtrusive element. Individuals who suffer from this psychosis sometimes cannot even come into the presence of strangers or any public situation without experiencing an attack of symptoms such as I have somewhat schematically described. The phenomena may be summarized as bashfulness, emotion of fear, inhibition, dissociation, limitation of the field of consciousness, ideas of self, confusion of thought and speech, inappropriate and delayed response, delusions of suspicion, tremor, palpitation, etc. ”

“ Again, an answer will, no doubt, be demanded by some people to the question—How does that which, objectively considered, is neurosis become subjectively felt as psychosis? Is not the identification of neurosis and psychosis a begging of the question, unless the how, the modus operandi, is explained? ”

“ 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. ”

“ No less interesting and instructive is a study of the voluntary cases. An analysis of 1,807 admissions of this type shows the following distribution of psychoses: alcoholic psychoses, 5.64 per cent; dementia praecox, 18.43 per cent; manic-depressive, 6.81 per cent; involution melancholia, .99 per cent; senile psychoses, 1.11 per [112] cent; general paresis, 7.9 per cent; epilepsy, 1.05 per cent; psychoneuroses, 3.59 per cent; and without psychosis, 34.64 per cent. ”

“ Psychosis is the most serious and incapacitating degree of mental illness. Emotional problems with symptoms of anxiety or depression, or both together, are called affective disorders. People who have affective disorders make up the majority of clients seen by most psychotherapists; these clients are not out of touch with reality. The problems that they have—though painful and sometimes obstacles to normal living—are essentially different from the difficulties that patients with psychoses have. ”

“ The older psychiatry regarded such a complete breakdown, which it labelled acute mania, as the expression of a mere disorderly jumble of disintegrated mental process, but if we look on the whole situation as a means of reacting to the conflict between suppressed instinctive tendencies and controlling forces, it becomes a question whether the acute psychosis, with all its apparent disorder, is not merely the expression of a victory of the instinctive forces running riot after their escape from a lifelong period of suppression and control. ”

“ In the first place, we must remember that the mental disorder, if it belongs to the group we are discussing here, is the result of a criminal act, and following in its wake, and that therefore the plea of insanity as an excuse for the deed must manifestly be excluded. But may not this type of reaction furnish us an index to the original personality of the culprit? In other words, should we consider an individual absolutely normal, if, in reaction to some stressful situation, he breaks down mentally and develops a psychosis? ”

“ Finding, as these individuals do, a successful and convenient refuge in a psychosis, it is but natural for them to again seek this refuge when they find themselves in conflict with the law. But that which was at one time a spontaneous, unconsciously motivated mental reaction may later become a conscious volitional act, an only available means of escape—malingering of mental symptoms. ”

“ How many times has it fallen to my share to soothe and counteract the fear instinct of panic-stricken psychopathic patients! A psychogenetic examination of every case of functional psychosis brings one invariably to the fundamental fear instinct.
Conflicts, repressions, imperfections, sex-complexes, sex-aberrations, and others do not produce psychopathic symptoms or neurotic states. It is only when mental states become associated with an exaggerated impulse of self-preservation and an intensified fear instinct that neurosis arises. ”

“ The other form in which malingering may be so intertwined with actual mental disease as to render accurate differentiation quite impossible is where the individual may be suffering from a psychosis at one time, and at some later period, finding himself in a stressful situation, malinger a psychotic state. In these cases the danger of ever committing a habitual criminal to a hospital for the insane is especially apparent. ”

“ There Can Be No Neurosis Without a Psychosis.—If the brain is the organ of the mind, then what affects the brain must perforce be at least registered by mind. So every physical shock, accident, toxic condition, infection—even the ordinary cold—rouses the mind at least to awareness, usually to discomfort. For the nerve-cells and fibers—those inseparable parts of the body mechanism—speedily report the fact that they are being tampered with. ”

“ If mental functions are differently selected for impairment in the different forms of psychosis, then we should expect diminished coefficients of correlation among the insane, because mixing the psychoses would produce inconsistency of rank within the group. If, however, certain functions were deteriorated in all or nearly all of the insane, others remaining intact, or relatively so, this selective enfeeblement would not appear in correlation coefficients. ”

“ The acute emotional reaction to all situations which this man manifests, the development of the psychosis in consequence of the depth of his feelings concerning the unpleasant experiences and the entire absence of this important incoördination between his feeling and acting, would, in itself be sufficient to separate his psychosis from dementia præcox. ”

“ In other types of psychopathic affections the patient is entirely unaware of the whole situation, he is engrossed by the symptoms which he regards as the sum and substance of his trouble; the fear is entirely subconscious. Frights, scares, dread of sickness, instructions associated with fear of the mysterious and unseen, injunctions with fear of punishment or failure in moral standards, enforcement of social customs with dread of failure and degradation,—all go to the cultivation of the fear instinct which in later life becomes manifested as functional psychosis or neurosis. ”

“ The chief symptoms are ill humor and irascibility or a jovial, careless, flippant, facetious mood; abusiveness to family, unreliability and tendency to prevarication; in some cases definite suspicions and jealousy; there is a general lessening of efficiency and capacity for physical and mental work; memory not seriously impaired. To be excluded are residual defects due to Korsakow's psychosis, or mental deterioration due to arteriosclerosis or to traumatic lesions. ”

“ When we remember that this man was far from being as ignorant as some of the above answers would suggest, and that, while he unquestionably suffered from a psychosis, his state of consciousness was altogether too clear to justify a degree of lack of touch with his environment such as his replies would indicate, it becomes quite obvious that he malingered. ”

“ In chronic cases delusions of persecution are often observed. The psychosis frequently does not develop until several weeks or months after the actual poisoning. Several observers have referred to a mask-like expression of the face, with emotional indifference, apathy and outbursts of laughter. The mood has been described as characterized by emotional instability. O'Malley calls attention to the important fact that the mental disturbance may have been the cause of suicidal attempts rather than a result of the gas poisoning. ”

“ The word psychosis has been proposed by Mr. Huxley. It has the advantage of being correlative to neurosis (the name applied by the same author to the corresponding nerve-process) , and is moreover technical and devoid of partial implications. But it has no verb or other grammatical form allied to it. ”

“ Statistically this extensive group contains by far the largest number of cases of psychosis. Many psychiatrists would prefer to limit it, and accordingly make use of other nomenclature and classification. From the psychological standpoint the change of name is unimportant, for it is of less value to know what a thing is called than to know what it is. The cases of mental disorder sketched in this essay belong to well-known and frequently occurring types, familiar to the alienist. The facts will not be altered if these disorders are called by some other name than dementia praecox. ”

“ The case being recognized after a few days as a psychosis, she was sent to the Observation Pavilion, where she was described as jumping about in bed in a jerky, purposeless manner, resistive when anything was done for her, and mute. Her sister reported that when she visited her the patient said "Go away, I am dead."
On admission she looked dazed, stared vacantly and had a tendency to draw the sheet over her. When put on her feet she let herself fall limply. ”

“ The two major divisions of mental disease—psychosis and psychoneurosis—are not always readily differentiated. In the psychotic, the personality is usually distorted, whereas in the psychoneurotic the personality remains normal in relation to the realities of the world and social life. The psychotic is the more [Pg 63] obviously deranged, the psychoneurotic usually passes for almost normal. ”

“ The modern trend in psychiatry is distinctly in the opposite direction. We no longer today insist upon material changes in cells and tissues for every psychotic phenomenon, but rather endeavor to investigate mental life, be it normal or abnormal, from the biologic point of view. We are being constantly confronted with the undeniable fact that whatever may be the physical substratum of mental disorder, it does not aid us in understanding the peculiar expression which a given psychosis chooses to assume. ”

“ One common occurrence is a slow deterioration of character and energy that proceeds for months or years before flagrantly psychotic symptoms appear.
Then when delusions or hallucinations are eventually spoken of by the patient, an appropriate or adequate reaction is lacking. In a benign psychosis false ideas do not appear with an equable mood unless the stupor reaction has already begun. ”

“ Individuals with such a disorder may manifest a disturbance of intrinsic personality patterns, exaggerated personality trends, or are persons ill primarily in terms of society and the prevailing culture. The latter or sociopathic reaction a re frequently symptomatic of a severe underlying neurosis of psychosis and frequently include those groups of individuals suffering from addiction or sexual deviation.' U.S.Code Cong. ”

“ Paranoia may be defined as a progressive psychosis founded on a hereditary basis, characterised by an early hypochondriacal stage, followed by a stage of systematisation of delusions of persecution, which are later transformed into systematised illusions of grandeur. ”

“ In isolated cases one may observe convulsive twitchings of the voluntary and involuntary musculature. Finally severe motor excitements set in. The patient becomes noisy, screams, runs aimlessly about, destroys and ruins everything that comes his way. With this the disease has reached its height. At this stage consciousness is entirely in abeyance and the disorder is followed by complete amnesia.” Reich supposes that this acute prison psychosis may be included in that large group of abnormal psychic processes, developing from affect and affect-like situations. ”