Clouston has thus classified the forms and varieties of insanity; Melancholia, comprising all states of depression, and having emotional depres sion or mental pain and sense of ill-be ing as its leading and dominant symp tom. There may in addition be loss of self-control, insane delusions, which are usually suggested by the depression or impulses toward suicide, as well as in capacity to follow ordinary avocations in melancholia. These distinguish it from sa. ne .melancholy. Suicide is the great ( risk in such cases; four-fifths of melan cholic cases being suicidal. The recov eries from melancholia are the most com plete of all forms of insanity. It would seem to be caused by a more entirely functional and dynamical brain disturb ance than any other form of insanity that may leave no trace whatever behind it after recovery.
Mania, comprising all states of mental exaltation, such as joyousness and rage, and commonly accompanied by muscular excitement, restlessness, sleeplessness, the speech tending to become incoherent, the conduct violent or uncontrolled. The symptoms range from a joyous elevation with talkativeness and merely want of common sense and foolish conduct up to complete incoherence, delirium, and rav ing madness, or "acute mania." Folie circulaire, or states of regular alterna tion between melancholia and mania, forms a small but distinct variety of in sanity.
Monomania, or delusional insanity, is that form where insane delusions are the chief signs of the mental aberration. In such cases the intellect is chiefly affected rather than the affective nature. The delusions are morbid in a particular di rection, the chief forms being monomania of grandeur or pride, of unseen agencies, and of unfounded suspicions. Electric ity, mesmerism, telephones, gases, noises made by imaginary persecutors are the common subjects of the second form; while utterly perverse interpretations of the conduct of friends or strangers is the common form of the latter. The two together are sometimes classed as mono mania of persecution. Hallucinations of the senses—i. e., imaginary sights, sounds, smells, and tastes—are very com mon in this form of insanity. It is not very curable -when the delusions get fixed.
Dementia, or conditions of general mental enfeeblement, is the state of mind where the memory is impaired, the rea soning weakened, the feelings diminished, the will especially lacking, the attention and curiosity far below normal, these changes having occurred in a person who had at one time been normally consti tuted. It is in fact silliness, want of mental force, imbecility not congenital, but acquired.
Stiepor, embraces those cases where there is mental torpor, in which impres sions on the senses produce no effect, the patient neither speaking nor taking. no tice of anything, and having no volition except to resist, but being able to stand, walk, and to eat. Trance and catalepsy are forms of stupor, the heart's action is low and the body is cold, and the muscle.s are flabby. Stupor commonly occurs in young people of both sexes, and is very curable, 50 per cent. recovering.
Impulsive insanity, or states of de fective control, is the most interesting of all the divisions of the mental classi fications, inasmuch as will is the highest of all the mental faculties, and volitional disturbances have a close relationship to morals, law, social life, and conduct. The children of insane or drunken par ents are lacking in the normal power of control, and in their perception of the sense of right and wrong, their conduct being apt to be impulsive and not guided by reasonable motives. All forms of in sanity are more or less distinguished by lessened control, but there are persons without general depression or excitement, insane delusions, or enfeeblement of mind, who will suddenly smash furni ture, tear clothing, steal, set things on fire, obey gross animal impulses, or kill themselves or others. The function of mental inhibition residing in the highest regions of the brain, controls mental ac tion in other portions of the brain con volutions. In this form of insanity it is supposed that the inhibitory controlling portions or "centers of mental inhibition" have lost their power.
Clinical Varieties.—Chief among these types of insanity is general paralysis, a specific disease of those portions of the brain that subserve mind and motion. It is always incurable, getting progres sively worse, gradually impairing and at length destroying speech, motion, mind, and, usually in about three years' time, life itself. In this form of insanity pa tients commonly have extravagant delu sions of wealth and power. Paralytic insanity is that connected with apoplex ies, softenings and tumors of the brain, which cause ordinary paralysis first, and one form of dementia afterward. Epi leptic insanity may accompany epilepsy. It is often attended by great violence and irritability, and by danger to those around the patient. Many murders are committed by insane epileptics. Syphi litic insanity is the result of brain poi soning by this terrible scourge of hu manity. Alcoholic insanity is a very frequent form. It may be very chort in duration or very long continued, or in curable. Rheumatic and gouty insani ties are very rare.