Psychosis

Causation and Treatment of Psychoses.

A psychosis is a disorder of behaviour, and represents a failure of function at the psychological level. Psychiatry (q.v.) thus differs in its subject matter from general medicine; the former deals with disturbances in the reactions of the organism as an integrated whole, and the latter with disorders of special systems of organs. Since the be haviour of an individual, whether normal or abnormal, depends upon an infinity of factors—the nature of his life situations, the state of his organism, and the whole of his past history, both personal and ancestral—it is impossible to select one factor as explanatory of the total reaction. The problem of causation in the psychoses is thus dissolved in relativity, and in each case an endeavour is made to seek out, and remove where possible, any factors, either physical or mental, which seem to be exerting an unfavourable influence upon the behaviour.

There is now a general tendency to approach the problems of mental disorder from the standpoints of biology, pathology and general medicine, as it is recognized that the psychoses must be the outcome of a malfunctioning organism. Many psychoses, indeed, have definite relationships to diseases of the nervous system and of the bodily organs, as well as to general disturbances due to infections, exhaustion and drug intoxications. The causal significance of foci of chronic infections from the nose, throat, teeth, uterus or intestines has recently been emphasized and investigations along these lines make it evident that the whole resources of medicine should he utilized in the treatment of mental disorder. Mind cannot be regarded as an entity and detached from the body, and the secrets of disordered personality cannot be dis covered by confining researches to the brain. The mind is not

merely a function of the brain; it is a function of the whole organism having its roots in the viscera, the endocrine glands, the vegetative nervous system and the musculature.

In contrast to the toxic-exhaustive group of psychoses or an organic psychosis such as general paralysis, which are accidental episodes in the life of normal people, the biogenetic psychoses are the outcome of an hereditary or constitutional predisposition to mental disease. The psychotic episodes may be excited by mental or physical stresses, but the tendency already exists. The different forms assumed by these psychoses are independent of any specific pathogenic agent and dependent upon the personality, make-up or inborn psychic constitution. Thus a manic-depressive psychosis is considered to exhibit an exaggeration of a pre-existing cyclothymic or extraverted temperament, and dementia praecox of a pre-existing schizophrenic or introverted temperament. Kretschmer has noted a relationship between certain forms of physique and these psychic types. His work sheds light on the organic foundations of temperament, and has an intimate bearing on the problem of the biogenetic psychoses.

The psychoses do not offer a fertile field for the application of formal psychotherapeutic procedures, such as hypnotism and psychoanalysis; their subjects lack insight and sense of illness, and tend to be non-co-operative and impenetrable. Indirectly, however, psychological treatment plays a large part in the pre vention, cure and amelioration of psychoses and psychogenetic factors largely influence for better or worse the reactions of a psychotic.