Forms Of Insanity Research Articles

The concept of disease and its implications for psychiatry.

It has often been suggested in recent years that there is no such thing as mental illness; that the conditions psychiatrists spend their time trying to treat ought not, properly speaking, to be regarded as illness at all, or even to be the concern of physicians. Szasz is the best-known exponent of this viewpoint, and the core of his argument is essentially this: that as prolonged search has never demonstrated any consistent physical abnormality in those regarded as mentally ill, and as their ‘illness' consists simply in behaving in ways that alarm or affront other people, or in believing things which other people do not believe, there is no justification for labelling them as ill, and to do so is to use the word illness in a purely metaphorical sense (Szasz, 1960). Schneider had previously been led by the same reasoning to the conclusion that neurotic illness and personality disorders were ‘abnormal varieties of sane mental life’ rather than disease, but he took care to exempt schizophrenia and cyclothymia by assuming that both would in time prove to possess an organic basis (Schneider, 1950). The argument Eysenck puts forward in the first edition of his textbook, though written from the quite different standpoint of academic psychology, is a similar one. After observing that ‘the term psychiatry does not denote any meaningful grouping of problems or subjects of study’ he went on to suggest that the traditional subject-matter of psychiatry should be divided into a small medical part ‘dealing with the effects of tumours, lesions, infections and other physical conditions' and a much larger behavioural part ‘dealing with disorders of behaviour acquired through the ordinary processes of learning’, thereby implying that most of what doctors regarded as mental illness was really learnt behaviour rather than disease, and therefore much better understood, and dealt with, by psychologists than by physicians (Eysenck, 1960). A third line of attack is provided by R. D. Laing, and a fourth is exemplified by the sociologist Scheff. Laing argues that schizophrenia, far from being a disease or a form of insanity, is really the only sane or rational way adolescents have of coping with the intolerable emotional pressures placed on them by society and their families (Laing, 1967). Scheff has developed the somewhat similar argument that what psychiatrists call mental illness is largely a response to the shock of being labelled and treated as insane and the expectations this produces; in other words that schizophrenia is created by the people and institutions that purport to treat it (Scheff, 1963).

Female arsonists.

Arson has long been a subject of interest to the psychiatrist. In the early nineteenth century, continental psychiatrists in particular maintained that pyromania was a form of insanity, and laws were enacted in the German States and in France to protect such persons from the death penalty. The underlying sexual roots of arson have been stressed (e.g. Stekel, 1924), and although Reiss (1909) suggested that it might represent any form of displaced emotional reaction to tension, and McKerracher and Dacre (1966) that it might represent displaced aggression, the view of a sexual basis for arson is still commonly held.

American Indians: Poets of the Cosmos

G E R A L D H AS L A M Sonoma State College American Indians: Poets of the Cosmos When Bufly Sainte-Marie sings— Has a change come about Uncle Sam, or are you still taking our land? The treaty forever George Washington signed. He did, dear lady. He did, dear man. And the treaty's being broken . . . Now that the buffalo’s gonel1 —she transcends history in a living communion with America’s oldest literary heritage; American Indians were and are the poets of the cosmos, the singers of America’s most vital songs. Miss Sainte Marie’s emotional vibratto evokes the centuries-old chants of her Cree forefathers, for Amerindian poetry is traditionally sung; to say it another way, Amerindian singing traditionally employs poetic language. And singing, as A. Grove Day observes, “was a way of tapping . . . superhuman force, and was used to obtain success in almost every act of Indian life.”2 Indeed, F. W. Hodge points out that “most Indian rituals can be classed as poetry. They always relate to serious subjects and are expressed in dignified language, and the words chosen to clothe the thought generally make rhythm.”3 Hodge might have also noted that Amerindian rituals, complete with their serious and rhythmic use of language and patterned movements, constitute dramatic forms. The border between prose and poetry is both more distinct and different among Amerindians than among European-American writers. Poetry is distinct in presentation, form, and content, often being concerned with transcendent subjects and explorations, and leading to forms of mystical experience. American Indians recog­ nize the magical power of language, and they seek to utilize it. 2Buffy Sainte-Maria, “Now That the Buffalo’s Gone,” as sung on her Vanguard album (VDS-79280) I’m Gonna Be A Country Girl Again. Gypsy Boy Music. 8A Grove Day, The Sky Clears: Poetry of Indian Indians (Lincoln, Neb., 1968), p. 2- •F. W. Hodge cited in Day, p. 2. 16 Western American Literature Prose, on the other hand, is an intoned form, stressing rhythmic aspects in its delivery, but never actually chanted to music. Day suggests the following characteristics which distinguish Amerindian poetry from prose: Poetry was used only on certain occasions; it was always rhythmic in form, and was chanted or sung, usually to the accompaniment of drums, or melodic instruments; and the composers made use of certain stylistic devices recognized as poetic—usually consisting of archaic, tersely suggestive, or imaginative language.4 While poetry was usually concerned with religious—in the animistic sense—subjects, prose was most often used to transfer the lessons of history, the secular information necessary for survival of the culture. Such information took the form of tales, parables and other short, complete forms of discourse; often, the tales were linked in long cycles of stories, producing the spoken equivalent of longer prose forms in written literature. The tacit historic assumptions of many Euro-Americans con­ cerning Amerindians—that they were savages who rode about scalp­ ing one another, or that they were silent, sullen people incapable of articulate expressions—demonstrates the wealth of misinformation our educational system has allowed to proliferate; between the stereotypes implanted in young minds by motion pictures and television, and the unwillingness or inability of educators to counter­ mand and correct such stereotypes, most Americans know little of American Indians as they actually were and are. There were approximately six hundred different cultures living in North America when Europeans first came here; no two cultures were exactly alike: “The Chippewa rode in a birchbark canoe, the Chicasaw in a dugout; the Sac slept in a bark wigwam, the Kiowa in a skin teepee, and the Pueblo in a stone apartment house. . . . The Papagos regarded was as a form of insanity, the Comanches gloried in it.”5 And, despite the uniform physical image projected in the popular media, “Red men came in as many different sizes and shapes and skin tones as the whites who were about to overwhelm them. The only features the Indian had in common were black hair, brown eyes, and some shade of brown skin.”6 4Day, p. 4. W illiam T. Hagan, American Indians (Chicago, 1961), p. 3.«Hagan...

BOOK REVIEWS

Book reviewed in this article:M. L. Kellmer Pringle and B. SutcliffeRemedial Education—an Experiment.S. R. Slavson: Child‐Centered Group Giiidance of Parents.N. Isaacs: New Light on Children's Ideas of Number.K. G. Gollier: The Social Purposes of Education.Harry Bakwin and Ruth Morris Bakwin: Clinical Management of Behavior Disorders in Children.Richard Harrison Shryock: Medicine and Society in America 1660–1860.John Conolly: The Croonian Lectures, (1849) On some forms of Insanity.

The Inheritance of Manic-Depressive Insanity and its Relation to Mental Defect

In the development of psychiatric genetics progress has been very largely dependent on the progress of clinical psychiatry. In the early days the theory of polymorphism held the field—that is the idea that there is a single hereditary basis for what may be called degeneration, which might show itself in many forms, any form of insanity, psychopathic character, criminality or mental defect. This theory was built up on the unclear psychiatry of the day, when the boundaries between different clinical states were vaguely drawn and largely in dispute. We are now passing out of this stage in clinical psychiatry, but the genetic theory that was built on it, the idea of polymorphism, still lingers on. It has been the stimulus to an immense amount of muddled research of no value. The time has come when this theory should be finally discarded. We are not entitled to think that different clinical conditions have the same genetic basis until such has been proved. From a factual point of view the accumulation of knowledge has shown it in a number of cases to be untenable. From a heuristic point of view it offers no possibilities of advance.

An Analytical Review of a Series of Cases of Insanity with Pregnancy

It has generally been considered by obstetricians and psychiatrists that the insanity of pregnancy, in common with other forms of insanity associated with the reproductive function, offers a favourable prognosis from the point of view of complete mental recovery of the mother. This standard view is to be found in most text-books on midwifery and mental diseases.

The Epileptic Psychosis

T HE mysterious disease known as epilepsy, with its cardinal symptoms of convulsions and loss of consciousness, is followed by a variety of mental disturbances, some permanent and others of only a transient character. It seems to make little or no difference whether the individual suffers from the mild or the severer type of convulsions, sooner or later he will show deterioration of the intellect, or the periodic occurrence of graver forms of insanity. Nevertheless, it may be stated as a general rule that the earlier the disease comes on, the greater the liability to mental deterioration and the more rapid the failure, while in those persons in whom the attacks begin in later years of life, the deteriorating process is much slower, owing to the stability of the nerve tracks acquired in infancy and youth. Epileptics who have had fits for years show a dimming of the reasoning faculties, defects of memory, alternations of character, a sinking to a lower plane of intelligence, and above all a tendency to impulsiveness and irritability. To this rule there are but infrequent exceptions. In many instances of the disease the epileptic is irritable even to violence, unmanageable, careless of the feelings of his family and friends, and is among the most difficult of mental cases to handle. As a general rule it may be stated that the more frequent the seizures, the more rapid the mental deterioration. There are, however, cases who have a great many attacks and who hold up mentally in a surprising manner in spite of the frequent assaults on the nervous system; again, there are cases with very infrequent seizures who deteriorate with great rapidity.

A Review of Blood-Pressures in the Insane

In this investigation of blood-pressures in the various forms of insanity, 920 male cases were examined. In order to reduce the numerous variable factors to a minimum, the following procedure was adopted.

THE PROGNOSIS OF INVOLUTION MELANCHOLIA

Involution sometimes spoken of simply as melancholia, is one of the most frequent forms of mental disease, and the term is one of the oldest in psychiatry. Nevertheless, the clinical position of this group and the outcome of the psychosis are still matters of dispute. Until 1907 the disease was generally held to be a clinical entity with variable prognosis. For instance, in the seventh edition of his textbook, Kraepelin says: It includes all pathological states of anxiety in more advanced age, which are not episodes in the course of other forms of insanity. Delusions belong also to this clinical picture in addition to the mood disturbances. As to the prognosis, he found that 32 per cent, of his cases were chronic, while 19 per cent, of his patients died within two years after the onset. Only one important objection was made to the view that involution melancholia is

The Identity of the Psychoses and the Neuroses

Half a century ago Maudsley wrote “A pregnant but very difficult question of which little or no thought has ever been taken by writers on insanity is—What is the cause of the particular form which the disorder takes in a given case? Why does it assume one complexion rather than another? At the outset it is certain that what appears to be the same cause shall occasion different forms of insanity in different persons and even in the same person at different periods of life, and that the same form of disorder shall be produced by different causes; this being so it is plain that the special determining conditions lie hidden in that unknown region which we call by such names as ‘temperament’ and ‘idiosyncrasy.’”

The Identity of the Psychoses and the Neuroses

Half a century ago Maudsley wrote “A pregnant but very difficult question of which little or no thought has ever been taken by writers on insanity is—What is the cause of the particular form which the disorder takes in a given case? Why does it assume one complexion rather than another? At the outset it is certain that what appears to be the same cause shall occasion different forms of insanity in different persons and even in the same person at different periods of life, and that the same form of disorder shall be produced by different causes; this being so it is plain that the special determining conditions lie hidden in that unknown region which we call by such names as ‘temperament’ and ‘idiosyncrasy.’”

The Identity of the Psychoses and the Neuroses

Half a century ago Maudsley wrote “A pregnant but very difficult question of which little or no thought has ever been taken by writers on insanity is—What is the cause of the particular form which the disorder takes in a given case? Why does it assume one complexion rather than another? At the outset it is certain that what appears to be the same cause shall occasion different forms of insanity in different persons and even in the same person at different periods of life, and that the same form of disorder shall be produced by different causes; this being so it is plain that the special determining conditions lie hidden in that unknown region which we call by such names as ‘temperament’ and ‘idiosyncrasy.’”

PSYCHOSES OTHER THAN PARETIC DEMENTIA IN SYPHILITIC INDIVIDUALS

The great multiplicity and variability of manifestations in syphilis of the nervous system is a well established fact, but the role of syphilis in mental affections, with the exception of paretic dementia, has been suspected only since 1879, when Fournier 1 expressed the following view: While syphilitic insanity has not yet a distinct place in nosology, nevertheless, personally, I feel that syphilis is apt to create cerebral disorders which may be considered as undisputable forms of insanity. Since then the relationship of syphilis to psychoses as cause and effect has been studied by a few observers, but as yet no definite opinion can be formed. The importance of this problem cannot be overestimated. The present contribution, which concerns twenty-three cases kept under observation for a long time, will perhaps enable one to elucidate some features of this difficult problem. Before entering into a discussion of the causal relationship between syphilis

The Classification of Mental Diseases in New York State

The preface of the first edition of the nomenclature of dis? eases, drawn up by a joint committee appointed by the Royal College of Physicians of London and published in 1869, de? clares that perfecting the statistical registration of dis? eases, with a view to the discovery of statistical truths con? cerning their history, nature and phenomena, the want of a generally recognized nomenclature of diseases has been felt as an indispensable condition. Further, that among the great ends of such a uniform nomenclature must be reckoned that of fixing definitely for all places the things about which medical observation is exercised, and of forming a steady basis upon which medical experience may be safely built. This committee was discussing the nomenclature of physical diseases, but its observations apply equally-well to mental dis? eases. The lack of a generally accepted classification of men? tal diseases makes it impossible at the present time to collect comparative data concerning the various forms of mental dis? eases in different states and countries. In taking the census of the insane in institutions in 1910, the federal Census Bureau found it impracticable to collect data concerning any specific forms of insanity, except the alcoholic psychoses and general paralysis, and the data collected concerning these are in part unreliable. In New York State, since 1889, four different systems of classification of mental diseases have been used. The first, a modification of the English classification, was used in a per? functory way, but with no pretense of scientific accuracy, from 1889 to 1902. Then a simplified form of the same classifica? tion was introduced, but this was no better applied than the first. In 1905 the new psychiatry was rung in and the old

The Physical Basis of Mental Disease

In bringing forward some evidence which would point to the biological course followed by some forms of nervous disease to be considered, I would first of all accept as a working hypothesis two generalisations which apply to all forms of disease. The first of these generalisations is that there is essentially no difference in kind between a physiological and a pathological process. The distinction is an arbitrary one; the course of disease is distinguished from that of health only in so far as it tends to compromise the continuation of a more or less perfect adaptation between the organism and its surroundings. There is no tendency in Nature either to kill or to cure; she is absolutely impartial as to the result of a conflict between organisms and a host; and it is a matter of complete indifference to her as to whether toxins are eliminated or not. In the same way diseases of the mind are the manifestation of a perfectly natural relation of the organism, such as it is, to the environment. If the mental processes are abnormal, it goes without saying that the brain must be acting abnormally whether the stimuli to abnormal action originate in the brain itself or in some other part of the body. For example, if a child with pneumonia be suffering from delirium and hallucinations, as is not infrequently the case, this must be considered a perfectly natural outcome of the relation of the brain to its environmental stimuli outside and inside the organism. The actual stimuli may originate in the intestine from masses of undigested food and the stimuli may play on the brain rendered hypersensitive by the toxins from the lungs; the process and its manifestations, as well as the final outcome, are matters in which nature plays an impartial part. It cannot be admitted that there is any form of nervous disease which does not come under this generalisation. It has been argued by some authorities that because insidious forms of insanity are marked only by the slightest variation from the normal course of mental life, and that because the mental abnormalities are only modifications, and often easily explainable modifications, of normal mental processes, that the so-called insanity originates in these processes, and not in the material substratum of the organism. The fallacy of such an interpretation is obvious; it is tantamount to saying that slight albuminuria is the cause underlying early disease of the kidneys, or that a slight ódema may have something to do with the origin of circulatory disease. It is only natural that in the milder forms of mental disease the abnormal manifestations of brain activity should resemble normal mental processes; and even in the most advanced forms of mental disease there must be a close resemblance between abnormal ideation and conduct and perfectly normal ideation and behaviour. Even in advanced cases of Bright's disease the urinary elimination is more normal than abnormal; the abnormal constituents do not differ so much in kind as in degree from those of urine from healthy kidneys. It is not to be expected that in kidney disease bile or some other substance foreign to the organ would be the chief constituent of the eliminated fluid. The signs of insanity in any given case are the natural products of normal brain action mingled with the products of abnormal action. This does not, of course, preclude the possibility that under certain circumstances these abnormal products, such as delusions, hallucinations and perverted conduct, may not themselves be the direct stimuli to further abnormalities. The suicidal character of pathological processes is well seen in other organs of the body. A diseased heart, for example, is its own worst enemy; it not only fails to supply sufficient nutrition to the rest of the organism, but it starves itself by its inability to contract and expand properly, thereby increasing its own weakness. In the same way, certain phenomena of abnormal brain processes are in all probability due to the recoil on the brain of its own abnormal products in the matter of ideation and conduct.

The Cerebro-Spinal Fluid in Certain Mental Conditions

There is a constant endeavour in psychiatry, as in other branches of medical science, to distinguish between organic and functional disorder. Year by year, in most of these other branches, the organic group becomes larger, the functional group smaller. But unfortunately the same cannot be said for psychiatry. When all is said and done, the term “functional disease” is largely a cloak for ignorance. Where there is disease there must be something to show for it, but if the changes are so subtle as to escape detection, we at once label the condition “functional.” General paralysis was considered a functional disease until it was proved to have a very solid anatomo-pathological basis; indeed, until this proof was forthcoming it could hardly be said to exist as a definite entity at all. Until this process is extended to other forms of insanity, clear thinking in psychiatry is impossible. We are still far too prone to look only upon the mental side of the cases which come under our care, whereas we ought diligently to search for some physical causal factor that may be at work, and for corresponding physical changes that may give us a clue to such a factor.

An Inquiry into the Occurrence of ah Inherited Tendency to Insanity in the Insane of a Rural Population

The important part played by heredity in the causation of insanity has long been recognised. Much has been written on the subject and investigations have frequently been made to show its influence. Owing to the complexity, variability and general indefinite character of insanity these inquiries have been mainly statistical. It is recognised that no form of insanity is of such definite and simple nature as to be readily available for study in its hereditary aspect by Mendelian methods. As has been repeatedly stated by various writers on the subject, it is not insanity, recognisable as such, that is inherited, but an abnormal nervous system liable to the development of the various conditions included in the term “insanity.”

A STUDY OF THE MILIARY PLAQUES FOUND IN BRAINS OF THE AGED

The central point of this study has been the miliary plaques commonly found in the brains of persons dying at an advanced age. Consideration, however, has been given many other factors which might have a causative relationship, or at least serve as an explanation for these peculiar structures. A reasonable number of cases, 89, have been studied more or less systematically and 4 other cases added to the supplementary group discussed under Section VIII brings the total to 93. Some of the findings lead to conclusions which may be stated with a degree of positiveness almost axiomatic; others still await interpretation. The results of this study may be summarized as follows: (1) While 87.5 per cent of plaque cases exhibited atrophy sufficiently marked to be detected with the unaided eye, other cases with equally marked atrophy were without plaques. Cases with brains weighing well within the range of accepted normal weight have shown plaques on microscopical examination, while other cases coming under the same category have been negative. (2) A large percentage, 62, of plaque brains exhibited gross focal lesions resulting from arteriosclerosis and all showed more or less advanced cerebral arteriosclerosis. But cerebral arteriosclerosis was even more pronounced in non-plaque brains. Arteriosclerosis per se, therefore, appears to have little, if any, direct causative relationship to the formation of plaques. (3) Brains exhibiting general histological evidence of senile involution, whether from persons dying insane, or from persons dying without psychosis, are the most likely to yield plaques. (4) Since plaques have been found in the brains of elderly persons dying insane and in the brains of elderly persons dying without psychosis, and also as recorded in the cases of a young tabetic without psychosis, these peculiar structures cannot be considered as characteristic for any special form of mental disease, although occurring with greater frequency in senile dementia than in any other form of insanity. (5) The onset of senile involution varies in different persons and this may explain the presence of plaques in the brains of some elderly persons and their absence in others. (6) From the evidence furnished by Case XV of this series and the published cases of Alzheimer and Perusini, a precocious senium is conceivable. By precocious senium something more than an early cerebral arteriosclerosis is meant. (7) Plaques when present in a given subject are more numerous in the portions of the brain which show the maximum of general pathological alterations. Hence in senile dementia the group of cases which shows the most frequent and extensive involvement, the frontal and hippocampal regions, as a rule, exhibit the greatest number of plaques. (8) The presence of plaques in the molecular layer of the cortex and in the white substance, often in great numbers, leads the writer to contend against an origin from degenerating ganglion cells. The view of deposited products of pathological metabolism resulting from degenerating nervous elements (fibrils) is advocated. The glial and also the apparently incontrovertible neural proliferations are interpreted as attempts at elimination of the deposited products. These attempts at elimination and replacement, nevertheless, do not appear successful. (9) The general histological evidence of these cases tends to show a similarity between the lesions of senile dementia and normal senile involution of the brain. The non-plaque cases of the series more nearly approximated the histological lesions of arteriosclerotic dementia. On the other hand certain non-plaque cases which coursed clinically as senile dementia did not show histologically, except by absence of plaques, lesions essentially different from the plaque cases. (10) Uncomplicated senile dementia, on histological grounds, appears, therefore, to be only an intensification of alterations found in normal senium.

On Insanity and Marriage

The subject of marriage and insanity is one which is at present beyond practical legislation in this country, but is of immense importance for the social stability and for individual welfare. Though we cannot legislate we have to advise, and our advice is sometimes taken. The lay public as a whole, and the majority of medical men, would at once reply to the question as to the insane ever being allowed to marry in the negative, but I shall contend that a dogmatic statement of this kind is unscientific and unpractical. Such a declaration is taking it for granted that all insanity is alike and is to be treated as of equal value. I shall begin, then, by saying that in my belief certain persons who have suffered from a degree of mental disorder which may be classed as insanity may yet recover and marry with no real increase of risk to their partner or to their children. If I say this, you will next expect me to give examples of the forms of insanity which I should consider as not being of vital importance.

Alcoholic Insanity (Korsakow's Polyneuritic Psychosis): Its Symptomatology and Pathology

There are certain persons who, having taken alcohol to excess, develop a form of insanity characterised by distinctive features, clinical and pathological. [This is the form which I mean by “alcoholic insanity.”]