Psychosis

PSYCHOSIS. Strictly speaking, the term psychosis means a state of mind, a concrete psychical process or a mental act; but is now generally used to signify an abnormal state of mind. This definition needs qualification, however, since the technical use of the term in psychiatry is confined to certain forms of mental disorder which can be distinguished from states of con genital mental deficiency on the one hand, and from "border land" conditions or neuroses on the other. A distinction should be made between "psychosis" and "insanity," which in popular and legal language signifies that an individual, owing to his state of mind, is unable to manage himself or his affairs, is in need of care and control and is not to be held accountable to society for his actions.

Psychosis, on the contrary, is a strictly medical term; it refers to a type of mental illness with certain intrinsic characteristics, assuming various forms, and due to a variety of causes. It does not necessarily lead to serious disturbances of behaviour, and there are many individuals who though not insane in a legal sense are nevertheless the subjects of a psychosis.

Psychological Considerations.--Though it

is convenient to divide mental disorders into different categories based upon their causation, clinical characteristics or course and outcome, so many transformations of the clinical syndromes occur that no hard and fast division into separate disease entities is possible.

One broad division is that made between the psychoses proper and the neuroses, a term embracing such morbid conditions as hysteria and obsessional neurosis. One of the essential features of a neurosis is the retention of what may be called the "herd sense," and a psychosis is marked by its diminution or loss. In a neurosis the patient is oriented to realities and has an intelligence alive to his own needs; his symptoms tend to be provoked by external circumstances, and he is sensitive to changes in the social atmosphere ; he sees facts as they are but meets them in a faulty way. He does not seriously offend against the conventions, and however exacting his conduct may be his entourage still regard him as akin to themselves—as, indeed, he is, since all persons are apt to exhibit mild neurotic symptoms when life becomes too complex and difficult.

In a psychosis, however, the irruption of images, feelings and cravings into consciousness leads to distorted views of reality and to falsification of facts; the sentiments and habits of the patient undergo a change, and his conduct becomes inexplicable and (apparently) unmotivated; he becomes indifferent to public opinion and impervious to solicitations from without; briefly, he loses touch with common life and lives in a world of his own.

Two Groups of Psychosis.

The differentiation by Kraepelin of the psychoses into two broad groups—manic-depressive in sanity and dementia praecox—has been of inestimable service to psychiatry, though his view that these should be regarded as distinct disease entities has not been established. It is more in accordance with clinical facts to regard them as two reaction types which sometimes occur in pure form but more often as mixed. The manic-depressive reaction is characterized by se vere and irregular fluctuations of mood in the directions of excitement and depression with intervals of normality. Dementia praecox tends to pursue an unfavourable course, and is character ized by a peculiar and often complete disorganization of person ality with predominant changes in the affective life and will.

As the disease does not always proceed to dementia, and may develop at any age, Bleuler prefers to apply to it the term schizophrenia (splitting of mind). Jung has stated that the essence of dementia praecox consists in the fact that the unconscious to a large extent replaces the conscious, and the validity of this formulation is clearly exemplified in those schizophrenics to whom the term paraphrenia is given. This psychosis is marked by the exuberant development of fantastic delusions and hallucinations, which appear all the more extraordinary as the personality is so preserved as to enable the patient to make a normal reaction to social life on occasions. The morbid mental products in these cases can properly be regarded as an echo of the ultimate realities of organic life.