In many cases the melancholic does not know any reason for his grievous depression. Sometimes, however, the searching and brooding over the source of his gloom gives rise to various morbid ideas ; he imagine% having committed a sin, and he believes himself to be the most wicked person on earth, one who will never be able to gain eternal beatitude, but be forever cursed. Or he may fancy that he is impoverished, or that he is suffering from an incurable disease. These thoughts are often added to an anxiety which may become so intense that it leads to acts of violence, to suicide, self-mutilation, or even to bloody deeds against others. The tormenting tension in which the patient has been so far is broken, in this case, in about the same manner as high pressure of steam explodes the boiler. Terrible delusions are also, as a rule, present in such instances. The patient imagines that he beholds his murderers ; he hears the gallows prepared for him ; he sees hell with all its terrors ; or he hears his children call anxiously for help.
Such depressed patients are dangerous to the utmost. It should be borne in mind that even those patients who are apparently but slightly depressed should never be trusted ; for persons who silently suffer their torments, and who for some time do not manifest any symptoms, are the very ones who often end their lives by suicide. Hence all melancholics, without excep
tion, must be carefully watched, and should be under supervision by night as well as by clay. They require rest and a very careful psychic treatment which, combined with strict watching, can generally be offered only by the trained nursing as practised in an institution. Nothing is accomplished, at least in the severe cases, with the constant " intention to console," even with religious comfort. It would be a still greater mistake to attempt to " cheer up " the patient by amusing him. This would be quite as nonsensi cal and cruel as sending a mother grieving for the death of her darling to see a comedy. The depressed periods may persist for several months, and then the patient may gradually emerge from his gloom and become normal. These patients, however, may develop other attacks of the same kind, or they may become mildly maniacal or wildly excited. The maniacal attacks may last a few months, and then clear up as did the melancholic attack. The usual history in these cases is to have several attacks of the disease. Usually the successive illnesses result in some grade of mental deterioration.
Other forms of insanity are general paresis (for which see the article BRAIN, SOFTENING OF), and senile dementia, which is treated under SENILITY. See also MENTAL DISEASES.