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Kinds of Insanity

person, mania, melancholia, idea, excitement, lead and activity

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Six general types of insanity are described, namely, Melancholia, Mania, Monomania, De mentia, Idiocy, and General Paralysis of the Insane. It is not meant that these are differ ent forms of insanity absolutely marked off from one another, for all the forms merge into one another. According to the unlit' features of the disease, as exhibited in a particular per son, is it pot into one or other of these (hisses. These main features or general characters will now be briefly described. Very many eases of all kinds begin by manifestations of altered feelings, generally feelings of a depressed and sorrowful character. The symptoms that lead to the person being classed as melancholic or maniacal, &c., develop afterwards.

Melancholia, or Morbid this form the depression of spirits is great, and may lead to the person withdrawing from society, and even from his dearest friends. All things and persons become repugnant to him. He is irritable, morose, and suspicious. Ile is often the victim of delusions or hallucinations —people are watching him, whispering about him, plotting against him ; the world is ruined and he is doomed ; or he is bewitched, possessed, magnetized. Such are the delusions which affect him. Sometimes the person imagines part of his body is made of glass, or has similar absurd notions.

As a result of all this misery the tendency to suicide is almost inevitable.

Melancholia may lead to attacks of mania, or of excitement bordering on it. Half of such cases recover in the end, though a relapse is to be feared. Recovery, which is usually gradual, is to be looked for within six or twelve months, and need not be expected after that time.

Hypochondriasis is a form of melancholia in which the person believes himself to be suffering from serious illness. He is troubled with all sorts of complaints, which he is con stantly discussing, watching, and seeking treat ment for.

Mania, or Morbid Excitement, may break out suddenly, but usually follows a period of depression like that of melancholia. At length, ' and perhaps by slow stages, the depression yields to excitement, displayed by quickness and loudness of speech, readiness to laughter or anger, and incessant bodily activity. The

activity may find vent in shouting, leaping, &c., may show itself by a sort of intellectual elevation, sparkling or witty speech and con versation, humorous sallies, or may be of a de graded sort, displaying itself by cursing, swear ing, violence and assault, or acts of shame and wantonness. Sleep is often diminished, and the state of restless activity may continue for days and nights without apparent fatigue of the patient. Delusions and hallucinations are present here also, but they have not the settled hold characteristic of melancholia.

Maniacal attacks are apt to be periodic, the return of the mania being in women deter mined frequently by the menstrual period. Mania is often alternated with melancholia.

Recovery is generally slow, though it may be sudden, and occurs most frequently within a year. After the end of the second year the case is nearly hopeless. If recovery do not take place the mania may become chronic, or may pass into dementia, unless death is caused by other disease, or by violence at the person's own hands.

Monomania is the form of insanity in which the person is possessed by some fixed idea. Frequently, apart from the particular idea, the person scents perfectly sane and intelligent, and no mental disorder is noted until the par ticular idea comes up. Sometimes, also, mono maniacs seem to avoid the delusion which affects them. The delusion may be of any kind. The person may imagine himself to be someemperor, statesman, orator, or poet. Under the influence of the dominating idea the person puts on airs suited to the character he is supposed to he, haughty and arrogant, or affable and conde scending. The delusion may be of a low font), and is manifested by moods suited to it. The person may imagine he is peculiarly con structed, and certain precautions must be taken with him. Thus he may suppose his head to be made of glass, &c. Monomania has less chance of cure than mania.

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