Disturbances of the activity of the will are present in psychic affections. In addition to diminution of will-power, every conceivable gradation may be found. Increased impulsion of activity may cause the patient to commit impulsive acts, NViliCh usually manifest the characteristics of morbidity by their mere senselessness. However, such a disturbance of the will is rarely an isolated phenomenon, but usually accompanies other morbid symptoms.
It was for some time assumed that a propensity to commit theft (kleptomania), or arson, or murder, might be present in otherwise sound persons ; but this opinion is false. These persons are mostly idiots or epileptics. As already indicated, many laymen believe that an insane person is no longer capable of uttering a single sensible word, and they take it for granted that he must needs act without reason in whatever he undertakes. It is most difficult for a layman to believe in the mental inferiority of a criminal who has displayed considerable cunning in his act. But it is not quite clear why a thief who suffers from delusions should lose his hankering after theft and his cunning dexterity on that account. On the contrary, insane persons are often very clever, shrewd, and quick-witted, a circumstance which greatly interferes with their treatment. The public is always ready to think of simulation. Simulation of insanity, however, is extremely rare ; and still more rarely does it remain undiscovered, as it requires not only persistence and skill, but also a thorough knowledge of its characteristic manifestations. It is by no means easy to pretend to be mentally diseased, for " there is method in madness." A contrary condition—namely, that insane persons endeavour to conceal their morbid ideas so as to be taken for mentally sound— is much more common.
The prospects of cure vary greatly in the different forms of mental affec tions. Patients with some types of insanity (such as general paresis) never recover ; others very frequently get well. It sometimes happens that lucid intervals in the course of a disease simulate recovery. Such apparent cures, lasting weeks or months, occur occasionally even in softening of the brain, which is an absolutely fatal disease. The " successful cures " of quacks can be readily explained in this manner.
The postulate " prevention is easier than cure " holds good also in mental affections. Great care is necessary in those who are hereditarily tainted. It frequently happens that a very young child displays various peculiarities of character, such as vivid imagination, ready impressionability, senseless manifestations of rage alternating with sentimental tenderness, romantic fancies, egotism, and untruthfulness ; and all these qualities are often asso ciated with such excellent talents that the parents are proud of their " prodigy of a child." But the fate of these prodigies is often sad enough. Owing
to their lack of mental equilibrium and strength of character, they rarely accomplish anything worth mentioning. Mental and physical hygiene, calm perseverance in education, a rational division of work and recreation, avoidance of mental emotions and over-exertion of a brain which requires rest—the precepts are so numerous, or, rather, they are so dissimilar, that they must needs be adapted to each individual case. It is important, under all circumstances, to bear in mind that one is dealing with abnormal characters, and that it is necessary to consult a physician as early as possible. Nerve specialists are usually consulted after the damage is irremediable.
The care of insane persons is often regarded as equivalent to their con finement in insane asylums ; yet scarcely more than fifty per cent. of all insane persons are in such institutions. When the home conditions are favourable, a harmless demented patient may remain with his family, although caution is necessary also in such cases. A very troublesome or dangerous patient, however, must necessarily be placed in an institution. In such institutions the patient is better protected ; and experience has taught that, with constant supervision by a physician, and with trained attendance, the prospects of recovery are far better than they would be if the patient were kept at home. Under no circumstances should one wait until the unfortunate patient has become demented. Hundreds of patients could have been cured if they had been placed in a sanatorium in time. The modern institutions for the insane are not prisons, but hospitals in the truest accepta tion of the word. A patient should never be brought to the hospital by cunning or by deception. The majority of the mentally afflicted are quite willing to follow if one insist calmly and firmly upon their going ; and, at worst, force is always better than deception. Until the patient is admitted, he should not be left without supervision, neither day nor night.
It should be borne in mind that a mentally deranged person is actually ill, and that a diseased brain can be cured neither with moral advice, admonitions, or punishments. The nervous system requires rest, bodily as well as mental. This forms the basis of all treatment. That even to-day demented persons are exorcised, as being " possessed by demons," is a fact which, unfortunately, cannot be denied. There remains only the comforting knowledge that such aberrations are not in the long run capable of arresting the victory of truth. For the various forms of mental deterioration, see IMBECILITY, and INSANITY.