Insanity equivalents and the gastro-enterologist

Abstract

In many cases, it is hard to explain the onset or the continuance of a nervous breakdown on the basis of any known strain, overwork or unhappiness. Oftentimes, it is particularly difficult to explain the feelings of apathy, fatigue, weakness and depression. Some patients with these troubles are operated upon repeatedly in the vain hope of finding the disease in the abdomen. They might have been spared the trouble and expense if the physician had asked more questions and had learned that the invalid was too tired and apathetic to read, too discouraged to work, and too nervous to rest. Often, the physician did not learn in time from the family how psychopathic, poorly inhibited, and poorly adjusted the patient had always been. While admitting that in some of these patients there are signs of a defect in the glands of internal secretion, I wish to emphasize the point that in many cases the principal or primary defect is probably in the brain and nervous system. I believe that the more or less unaccountable type of nervous breakdown, with profound asthenia, which lasts for years or throughout a long life is often an equivalent of insanity. It is a milder manifestation of the defect which, in other members of the family, has produced definite mental aberration. The sudden and unaccountable increases in asthenia and nervousness which are seen in these people are probably comparable with the flare-ups which occur at intervals during the lifetime of patients who are subject to manic depressive insanity.