Chapter 21

VARIATIONS FROM NORMAL MENTAL PROCESSES (Continued)

_Hyperesthesia_ is abnormal sensitiveness to stimulation.

_Anesthesia_ is loss, either temporary or permanent, of any of the senses.

_Perversion_ is morbid alteration of function which may occur in emotional, intellectual, or volitional fields.

Example: The odor of a rose causing an acute sense of physical pain.

An _illusion_ is a false interpretation of a perception.

The normal mind is quite subject to illusions, either due to a faulty sense organ, or to a preconceived state of mind which so strongly expects or presages something else than reality as to misinterpret what the senses bring.

Examples: The crooked stick as a snake. A ghost created from shadow. An ordinary ringing in the ears as sleigh-bells. Milk tasting like blood.

An _hallucination_ is a perception without an object.

The hallucinated individual projects, as it were, the things of his mind's creation into the outer world, and accepts them as reality. He sees snakes where there is nothing to suggest them; sees a ghost where there is no shadow; believes that the taste of blood is constantly in his mouth.

There are possible hallucinations of every sense. Nonexistent objects are seen, touched, tasted, heard, or smelled.

_Hypochondriasis_ is a state characterized by persistent ideas of non-existent physical disabilities.

The hypochondriac has every known symptom of indigestion, or of heart disease, or is threatened with tuberculosis--all in his mind; and whatever the disorder he seizes upon, his attention hovers there, while the ideas of that particular disability persist and strengthen.

A _flight of ideas_ is an abnormal rapidity of the _stream of thought_.

Every perception so immediately is linked with some association of experience that expression is swift and often incoherent. One word will follow another with amazing rapidity, words suggested by sound association, usually, rather than by that of meaning.

Example: "Made a rhyme, had a dime, did a crime, got the time, bring some lime." This association by rhyme is quite common. But the associations of meaning are not uncommon.

Example: "Made a rhyme. Mary was a poet. Mary had a little lamb. Where's Mary?--Mary!--No Jim--Jim, all my children--calling, calling, calling," etc.

A _fixed idea_ is one which morbidly stays in the mind and cannot be changed by reason.

Example: In hypochondriasis, as given above.

_Ideogenous pains_ are either pains born of an erroneous idea, or mental reproductions of pains now having no physical cause.

A suggestible person, learning that his grandfather died of an organic heart, conceives the idea that he has inherited the trouble, and begins to suffer cardiac pains; and as long as the idea persists the pain is felt.

_Compulsive ideas_ are ideas which intrude, recur, and persist despite reason and will.

Example: The compulsive idea of contamination may lead its victim to wash and rewash his hands at every contact with matter, until finally, though they are raw and sore, he is incapable of resisting the act.

_Disorientation_ is a state of mental confusion as to time, place, or identity.

_Amnesia_ is pathologic forgetfulness.

Example: As sometimes found in the infection-exhaustion psychoses, when the entire past of the patient may be wiped out for the time. Cases of permanent amnesia are known.

_Aphasia_ is a defect in the interpretation or production of language.

There may be motor aphasia, auditory aphasia, vocal aphasia, sight aphasia; and with disability to produce words, they may yet be recognized when seen; or when they can be spoken they may not be recognized when heard; or with inability to speak them, they are accurately sensed by hearing; or though understood when heard, they are incomprehensible when read.

A _delusion_ is a false belief which cannot be corrected by reason.

A _somatic delusion_ is one centering upon alterations in the organs or their functions.

Example: Absence of a stomach, inability to swallow.

A _nihilistic delusion_ is one which denies existence in whole or part.

Example: Mother denies the existence of her child.

A _delusion of reference_ is one in which the deluded individual believes himself an object of written, spoken, or implied comment.

Example: The actors on the stage are directing their remarks directly against the victim in the box.

A _shut-in personality_ is one that habitually responds inadequately to normal social appeal.

_Sense of unreality_ is one of the commonest psychic alterations through which customary sensation states are displaced by unnatural and usually distressing ones.

Examples: The breakfast table appears undefinably altered. Laughter is accompanied by strange, rather than by normal, sensations.

_Morbid inhibition_ is an abnormal, negative activity of the will.

Sometimes a patient will try pitifully to express some thought or feeling; the desire to explain is there, but will is blocked in action. Or the patient attempts to dress, makes repeated new beginnings, but cannot succeed. We say, "He is inhibited."

An _obsession_ is an idea which morbidly dominates the mind, constantly suggesting irrational action.

Obsessed patients may consistently step in such a way as to avoid the juncture of the flagstones on the pavement; may insist on removing their shoes in church; may hail each person met on the street and tap him on the arm; may refuse to ever leave the house without an open umbrella; or may try to attack every man they see, not because they want to hurt or kill, but because they are obsessed to the performance of the action.

A _tic_ is a useless, habitual spasm of a muscle imitating a once purposeful action.

Motor tics, such as habitual jerking of the arms, shrugging the shoulder, contorting the face, shaking or nodding the head, snapping the fingers, etc., are very common among nervous children, and even in many otherwise normal grown-ups.

_Distractibility_ is an abnormal variation of attention.

The common inability of the hypomanic patient to hold his attention to any subject when another is open, is very like the distractibility of the child who turns to every new interest as it is presented.

_Negativism_ is a state of persistent compulsion to contrary response to suggestion.

It is with these patients as though not only initiative were lost but also the power to follow another's lead. But their independence asserts itself in opposing every suggestion and in acting so far as possible contrary to it.

_Mutism_, as used in psychiatry, is an abnormal inhibition to speech.

Patients sometimes speak no word in many months. To all appearance they are true mutes. Then suddenly something may remove the mental blockade and they talk.

_Compulsive acts_ are acts contrary to reason, which the will cannot prevent.

A seemingly quite normal patient will sometimes grab a vase from a stand in passing, and dash it to the floor. Something "urged" him to do it, and he could not resist. Others will tear their clothes to shreds, not in anger, but because they "could not help it."

_Psychomotor overactivity_ is abnormal activity of both mind and body, contrary to reason and uncontrolled by will.

_Psychomotor retardation_ is an underactivity of both mind and body in which consciousness is dulled and the body sluggish.

A _neurosis_ is a disorder of the nerves, which may be functional or organic.

_Nervousness_ is properly termed a _psychoneurosis_--for we have learned that there can be no neurosis without an accompanying psychosis.

_Psychosis_ is the technical synonym for insanity.

_Borderland_ disorders constitute a group in which mental perversions do not yet so dominate reactions as to make them irrational.

Twilight is neither night nor day; the feelings of the hysteric are not insane, but the actions may be.

_Insanity_ is a prolonged departure from the individual's normal standard of thinking, feeling, and acting.

_Mania_ is insane excitement.

_Melancholia_ is the inability of the mind to react to any stimulus with other than gloom and depression.

Melancholia may be of the intellectual type or of the emotional type. The patient who tells you constantly that he has murdered all his children, that he is a criminal beyond the power of God to redeem, who seems chained to his delusions, yet shows no adequate feeling reaction, no genuine sorrow, we call a case of the intellectual type of melancholia. Another patient misinterprets every normal reason for happiness until it becomes a cause of settled foreboding. The mother, whose son fought safely through the war and is now returning to her, feels that his coming forecasts calamity for him. He had better have died in France. She is of the emotional type of melancholia.

_Hysteria_ is a nervous disorder based upon suggestibility, and capable of imitating most known diseases.

_Insane impulses_ are morbid demands for reckless action beyond the control of the will.

Example: The impulse to kill, quite regardless of who may be the victim.

_Psychopathic personality_ is a term much used today to designate an hereditary tendency on the part of the individual to mental disorder.

The _neuropath_ is the individual with an inborn tendency to the neurosis.

_Neurotic_ is a term broadly employed for the nervous in whom emotions predominate over reason.

_Neurasthenia_ is a nervous disorder characterized by undue fatiguability.

_Psychasthenia_ is a nervous disorder characterized by a sense of unreality, weakness of will, self-accusation, and usually by phobias and obsessions, all subject to temporary correction by reason or influence from without.

_Hypochondriasis_ is a disorder characterized by morbid attention to bodily sensations, and insistent ideas of bodily disorder.

_Phobia_ is a morbid fear or dread.

FACTORS CAUSING VARIATIONS FROM NORMAL MENTAL PROCESSES

HEREDITY

When we consider the accumulated possibilities for disorder which the family tree of almost any one of us can show, the wonder is not that there are so many nervous or insane, but rather that any come within hailing distance of the normal. For multitudes are born of parents whose bodies were food poisoned or alcohol or drug poisoned, and whose nervous systems were tense and irritable, oversensitive, and suffering from the effect of these same toxins on the brain. Others are of manic-depressive parentage; some are possibly even of paranoic or dementia præcox lineage; while many of our finest and best had psychopathic or neuropathic heredity. Syphilis, itself, and the underpower bodies of tuberculosis are heritages of many.

When we realize, too, that we are born with certain inherent tendencies of temperament, which are too often of the melancholic or overcholeric type, our wonder grows that we are not doomed to defeat at birth. Were it not for the possibilities in the germ-plasm of choosing the much of good also in our heredity, often enough to overbalance the bad, and for the proved power of environment and training to modify or even altogether overcome the harmful parts of our birthright, there would be little hope for many.

ENVIRONMENT

While environment may prove the saving grace from poor heredity, it may itself add heavily to the debit side. With the very best of health backgrounds, environment may damage body and mind beyond repair. Under environment we include everything that touches life from without--people, things, work, play, home, school, social life, business life, college-life, etc. Among factors of environment damaging to mental health are overemotional family life, overstrict home discipline or the lack of needed discipline; overfeeding, underfeeding, wrong diet, lack of proper exercise, stimulants, drugs, overstimulation, overprotection, too much hardship and privation, loneliness, poor educational methods, immorality, etc.

PERSONAL REACTIONS

What will decide whether a human being can resist, successfully, bad tendencies in heredity, or in environment, or in both, and keep a reasonably balanced mind? It demands insight, ambition, will; and if these remain the body can be forced to saving ways of health, and body and mind can largely make their own environment. But with heavy handicaps of heredity or environment, or both, and poor insight, or lack of desire, or weak will, nothing can save the mind from neurotic taint or worse--nothing but obedience to some one strong enough to control the habits of that life, until self-control is born. And there is a hope that it _can_ be born in the most neurotic or neurasthenic, so long as the mind is sane.

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. Many neurotics, neurasthenics, and hysterics are curable if they will seriously undertake to fulfil the laws of physical and mental health--simple laws, but ones which demand a strengthened will to carry out.