Epilepsy and various convulsive types cl reaction including the classical epilepsy, sear attenuated forms such as affect epilepsies, and those of gross brain disease, constitute a dais mental disease in which there is well-knows physiological and anatomical change in the brain itself. The disease is apparently hered tary, in the sense that in the history of all ep leptics there is usually to be found some tar in the family or in collateral branches. TM epileptic convulsion of the classical type is a spasm with unconsciousness, preceded by i warning called the aura, and followed by a gradual wakening or a cheep sleep. The vari ations are exceedingly numerous. Modern m vestigation has shown that there is some asse dation between the epileptic fit and the grao fication of an unconscious wish. Epileptics an likely to be of a low order of intelligence ant their reactions to be analogous to those of chi: dren or infants. Some cases indeed do tors out later to be imbeciles. Treatment is on generally considered to- be of avail, except sibly in psychogenic cases, where analysis sometimes straighten out the complexes of tht patient. The best care is secured in the cokeo plan where training in healthful outdoor oat pation is possible.
The Dementia Precos group of mental diseases contains the so-callei dementia simplex, hebephrenia, catatonia, sour paranoid forms and certain mixed or atypici. states. The mental symptoms of the dementia precox group include an emotional dullness. which is thought to be due to the fact that ii this disease the patient shuts himself into bn own thoughts and is therefore less moved !‘, external occurrences than are ordinary persons That is, his thoughts lose their reference to external reality and the result in the worg cases is that nothing in external reality am move or arouse the confirmed dementia preres patient. Another feature which is an outconn of this segregation from external interests is his so-called negativism, which is shown in his either refusing entirely to do what he is told or doing it as negatively as possible. Thus. if he is told to hold out his hand, he puts it be hind his back; if told to stick out his tongue, he shuts his mouth tight. This segregation of the behavior from all relations with external reality (and in the last analysis reality amounts to little more than the relations of the indi vidnal with other persons), is a splitting of the personality, which is the reason for the alter nate name of dementia precox: schizophrenia or °split mind." The detailed features of this separation of the behavior from all that in the average man is in close connection with his behavior are as numerous as all the possible types of relation of the individual with his environment. Some of these are suggestibility, failure of voluntary attention, disturbance of orientation, disorders of memory. The delu sions have been shown in many cases to be svmbolisms of the conflict going on in the unconscious. The fact that the conflict is un conscious accounts for the difficulty of getting at it and of re-establishing satisfactory relations with the patient. Other symptoms are physical such as the mannerisms, stereotyped modes of action, unusual words or expressions so quent in dementia precox, and the rigidity and stupor which characterize some of the patients.
Whatever reactions to the environment re main in the patient are marked by an archaic or primeval character, such that in the evolu tion of human behavior the highest, most com plicated and latest acquired types are those first to be lost. In the disease the individual reverts or regresses to a form of behavior which may possibly be supposed to have been valid and current in prehistoric ages. As be havior may be regarded as built outward from a central core, this form of psychosis is what is known as an introversional one, that is, one in which the libido introverts or regresses to a more fundamental and therefore more archaic form of gratification. There are other physi cal concomitants sometimes noticed, such as an unusually small heart or a tendency to pulmo nary tuberculosis. The onset of the disease is either gradual or sudden. If gradual it may be mistaken at the beginning for other types of mental disease, such as the manic-depressive, hysteria, compulsion neurosis, etc. It is in this disease more difficult than in most others to make any satisfactory statement as to whether it has a physical or a mental origin. As the bodily changes so far discovered have been so few and their bearing so uncertain, it is more advantageous at the present time to explain the disorder on a purely psychological basis. The patient is faced with a situation in which the balance between environment and congen ital ability to adapt to it is inevitably lost, whether because of the disproportionate burden placed upon him by his environment or because of his innate weakness rendering him unable to support the average load. In this connection it is to he remembered that many ordinary persons declare their burden is too heavy for them to bear, and that few ever know their extreme abilities; consequently the loss of bal ance may have a purely psychical cause lying within the unconscious desire of the particular person. When a person says that something will drive him crazy, he is unwittingly express ing an unconscious desire, not to become ill mentally, but to receive the care and symbolic homage which is given to the mentally ill. The severity of the mental symptoms may be re garded as a measure of how far the unfavor ableness of the environment has driven back the individual patient from reality. There are cases of moderate confusion which appear in almost all respects perfectly natural persons, and only later develop a disorder great enough to dissociate them from their fellows; while in the so-called catatonic cases the inability is gen erally complete. The cases which have subse quently become well have gradually made an adjustment to reality in some form, either indirectly through the formation of delusions, or directly by a final domination of the reality motive. Cases that do not get well tend to sink to lower levels till they reach one on which they can succeed in maintaining themselves with comparative steadiness. This is notably the case in institutions, while in the world of life such persons join the ranks of tramps, prostitutes and petty criminals, thus finding their appropriate level.