Early mental disease.

Date:: 1912

Catalogue details

Licence: In copyright

Credit: Early mental disease. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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so dreaded contamination that, after touching or handling anything, she invariably washed her hands ; she even thought the water she had used for this purpose was contaminated, so that she was compelled to wash her hands again; even her gloves required washing, because they possessed pores through which she thought defilement might pass. She recognised the absurdity of her ideas, and yet, after the doctor had felt her pulse, she took a handkerchief from her pocket, moistened it with eau de Cologne from a phial, and wiped the spot which his finger had touched. Then we have claustrophobia, the fear of closed spaces, and agoraphobia, the fear of wide spaces. There are many people who fear to cross a wide space or a broad street alone ; it is not the risks of an accident they dread, but they have a morbid terror at the seemingly illimitable space they have to traverse before reaching safety on the other side. It is curious that such persons can often cross quite easily, and without any fear, if they have a companion with them. Under agoraphobia we may include fear of spaces above as weU as around. Grainger Stewart tells of a patient who could sit in coinfort in church when under a gallery, the close proximity of the roof to her head giving her a feeling of security which she could not obtain in the body of the lofty building. The fear of precipices (cremnophobia) or of summits {acrophobia) are similar conditions to those of agoraphobia—the fear essentially is lest an impulse to precipitate should be given way to. The swaying of such a bridge as the Clifton suspension bridge, the rushing water below, and the examples of many previous suicides, made the bridge particularly dangerous to this class of persons. A similar fear sometimes seizes many when standing on a railway-station platform as an express train rushes past; the sensation is increased by the suction caused by a rapidly moving object, and victims of this phobia have thrown themselves in front of the train on impulse. Both women and men occasionally have an intense dread of intruding themselves in society gatherings, a condition being thereby aroused so distressing to the victim that it forms a handicap to some women in their social duties. Such individuals are very self-conscious, they blush readily, they imagine the company is talking about them, and should they be looked at, or even should a pause occur in conversation as they enter the room, a miserable feeling is set up that they had been the subject of talking, and that everything they say wiU be noted and become the subject of gossip afterwards. It can easily be understood how such experiences might lead, in time, to the development of actual delusions of suspicion or persecution, and so on to insanity. Persons who are deaf are very apt to develop such delusions. There is the reverse condition, a fear of solitude, as when a man, under the fixed idea that he is unable to leave his house unaccompanied, pays an employee to be his constant companion. Lastly, we may refer to cases, mostly females, who experience intense fear of animals (zoophobia), especially such harmless ones as mice, beetles, and spiders. Cases are known where the mere proximity of some animals will cause them to be actually ill. The emanations and smell of certain animals, such as the horse, have been known to set up an attack of asthma in persons subject to this disease, and the researches by Dr. J. Freeman into the toxic idiopathies are of interest in this connexion. (3) Obsessions of Iebesistible Propensities. Obsessions of irresistible propensities are those in which the fixed idea has for its effect not a fear but an irresistible impulse. These obsessions more closely approach insanity than the other forms. We have examples of this obsession in such conditions as onomatomania, kleptomania, pyromania, dipsomania, erotomania, suicidal and homicidal impulses. Onomatomania is a condition in which the obsession is the distressful seeking for a word, lost in the memory. Advancing years bring to all people the annoyance of being unable to recall a name, but in onomatomania there is, in addition— and it is this which constitutes the disease—an irresistible impulse to repeat some name or some word that will obtrude itself on the attention. Thus, in this form of obsession, there is forget- fulness of names, and an irresistible impulse to repeat certain names which the subject appears forced to utter. The literature of psychiatry is replete with instances where a forgotten name, word, number, or date has been a constant and recurrent torture to ill-balanced individuals. But to be unable to find the word may be replaced by an irresistible impulse to say the wrong thing—to swear or blaspheme, in season and out of season. Highly educated and weU-bred women suffering from this obsession are sometimes unable to restrain themselves from uttering obscene language pubHcly, and when they reahse what they have done their distress is very real. It is a well-known fact that among the insane we occasionally find strictly brought up women, nurtured amidst refined and often rehgious surroundings, who so far as can be ascertained have never been within hearing of such terms, giving expression to absolute filth. It is impossible to explain this phenomenon except by assuming that the language had been heard at some time or another. Patients who are possessed by this obsession are generally high in the scale of mental degeneration, and suffer from a loss of mental equiUbrium ; the most trivial cause may start the symptoms that usher in an attack, which is associated with a disproportionate distress. The irresistible impulse to repeat coarse or obscene words is frequently associated with tics ; there are jerky movements of certain parts of the body, shrugging the shoulders, blinking the eyes, sudden blowing of the nose, grunting, or spitting, and these movements occur before the explosive ejaculation of vUe language. The tics are the stigmata of hereditary neuropathy. Kleptomania is the irresistible impulse to steal* While Savage places this disease among his cases of moral insanity, Regis considers it as an obsession, and within the borderland class. It is