UNCONTROLLABLE IDEAS (OR CONCEPTIONS) These apparently are the original causes of the phobias. Thus Oppenheim relates of a girl 10 years old, "who in early childhood was seized with violent attacks of fright when one of the family', especially her father or mother, left the house. The child would stand in the doorway or at the window, trembling with fear and excitement, and could not be induced to move until the parents returned. In the course of treatment the condition became worse, so that the mother could not even leave the room, and filially the child developed a permanent con dition of fright which so completely dominated all her thoughts and actions that it resembled insanity in every respect. It required very searching investigation to determine that an uncontrollable idea, namely, that an accident might happen to one of her family, was at the bottom of her trouble and was the only cause for the child's peculiar behavior. There was an entire lack of characteristic features of illusions because, as 60011 as the paroxysm of fear had passed, the child was fully aware that nothing would happen to its parents, and, in fact, realized that her fear was morbid." After Oppenhcim had recognized the nature of the disease lie succeeded by suitable treatment in bringing about a con siderable improvement in the child's condition.
This case illustrates the peculiarity of uncontrollable ideas, which was emphasized by Westphal, namely, that the idea is felt by the patient to be something unusual and morbid, although at the same time it can not be suppressed either by an effort of the will or by corrective counter ideas. In other words, the condition differs from illusion in that the patient is aware of his malady. This consciousness, however, as Pick has pointed out, may be absent in young children whose intelligence is not yet sufficiently developed, but such absence should not be taken as a sign of illusion or insanity.
In children, as in adults, uncontrollable icleas assume various forms, and some have a greater pathologic significance than others. As most
children do not willingly reveal their inner lives, it often happens that the physician first hears of the existence of the forced ideas in the pa tient's childhood from the latter's own lips after he has grown up. In other cases uncontrollable actions, which are the result of uncon trollable ideas, lead to the early recognition of the abnormality.
The latter variety of forced or uncontrollable ideas is always to be regarded as pathologic, whereas many milder forms, such as an uncontrollable iinpulse to count the houses or lamp-posts, to step on the craeks of the pavement, and the like, appear to be quite common among children. Sometimes a child becon)cs aware of the meaningless ness of its thoughts and makes an attempt to break up the habit; some times the habit is begun as a mere pastime and is soon given up.
Of the many grayer forms that oecur in adults, not a few have been observed in children, such as metaphysical mania, doubting mania, (folie du doute), fear of having committed the unpardonable sin, and recollection mania, which reveal themselves in the child's behavior by an unintelligible inhibition of certain actions only, or of all forms of activity', while others cause t.he child to perform abnormal actions, as, for example, overscrupulousness which manifests itself in a peculiar, exaggerated exactness and pedantry quite foreign to childish nature, or the fear of getting dirty, as the result of which the child is constantly and incessantly washing itself, particularly its hands (uncontrollable desire to wash).
It appears from the foregoing that the diagnosis of the various forms of phobia and uncontrollable ideas may be extremely difficult. The important point is to bear them in mind whenever we are told of any unusual acts of commission or omission in connection with the child, and to try by careful, skilful questioning to gain an insight into the inner (psychic) life of the child.
The prognosis in general is not unfavorable. The treatment is purely educational.