The psychological symptoms of individuals who are mentally ill indicate the nature of their difficulties and the means which they are bring ing to bear to meet them. They indicate, in other words, the existing status of the problem of adjustment with which they are confronted, the degree and character of the failure.
The most familiar symptom of mental illness is delirium which commonly accompanies poisoning, as by alcohol (drunkenness, delirium tremens) or some physical illness particularly when accompanied by infection and high fever. In delirium theprincipal mental symptom is that of confusion. The patient sees all sorts of things which pass before his vision in kaleido scopic procession and hears voices, sometimes emanating from the people of his visions, some times just coming out of space. These false perceptions — hallucinations — are the charac teristic phenomena of delirium and to the on looker seem quite meaningless and incoherent. When the patient gets well, however, it is pos sible to trace their references and to appreci ate that they represent the outcroppings of wor ries, anxieties and impulses which had before been held in check. Delirium results when ill ness removes the power of efficient reaction and releases all those tendencies which otherwise had been under control. There is little capacity for adjustment. With recovery from the physical illness the delirium tends to subside. Similarly when we see a picture like this, a deliriod type of reaction but not the result of physical illness we feel that the powers of ad justment are pretty well broken, that the con structive forces of the personality are in abey ance.
Delusions are false beliefs which represent a somewhat more definite situation as between the stresses and the personality. Delusions always represent definite attempts at adjustment, but because they are not successful, only com promises. The weak man believes himself strong, the poor man rich, while quite com monly the recognition of weakness within as a cause of failure is avoided by the delusion that malicious influences from without are the cause of the trouble. This is the mechanism of pro jection and is at the basis of delusions of per secution which are so characteristic of that mental disease known as paranoia and all sorts of paranoid types of reaction in other mental illnesses and also of those unhappy individuals who are always filled with suspicions of those about them.
Hallucinations and delusions may be the passing phenomena of some acute upset or, on the contrary, they may become fixed, stereo typed and definitely organized into a system which is relatively unshakable and remains un changed over long periods of time. Such a system represents a type of reaction to a de fect of personality make-up which is the best that the individual can do and so comes to be a final solution. The delusion is like the scar tissue that fills up a wound. It remains perma nently as a disfigurement but it nevertheless represents what has been accomplished by the repair processes.
In still milder forms of mental illness, the neuroses and the psycho-neuroses, conditions that are on the borderline between the normal and the abnormal and are consistent with a considerable capacity for adaptation and ap parent normality, the forms which the symp toms take are somewhat different. They take on the character of what are called obsessions or compulsions. The patient is the victim of certain ideas, feelings or necessities for action which he recognizes as abnormal or foolish but which he cannot control. Thus in the realm of abnormal ideas he may be forced to think certain disagreeable thoughts, he may be ob sessed to think of certain numbers or certain phrases will recur to mind persistently or he may be forced to think how the people he meets would look if they were dead. The obsessive emotions come similarly without apparent rea son. He may feel a nameless fear or anxiety or be depressed without apparent cause or he may have definite fears of certain things or situations — the phobias— such as claustro phobia, fear of closed spaces, misophobia, fear of contamination, etc. Compulsive acts are equally common. The patient may be forced to touch every tree he passes or forced to step over every crack or start upstairs always with the same foot. In this group are the so-called manias such as kleptomania, the necessity for stealing, although there may be no desire for the stolen object, pyromania the necessity for set ting fires, etc. All of these tendencies represent instinctive trends which force themselves to ex pression but which, because they demand for their satisfaction inacceptable forms of conduct seek these devious ways of expression by at taching themselves to what usually appear to be unimportant activities.