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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    the majority of cases the severity of the symptoms will largely depend upon the preceding sensitivity of the nervous system. When one comes to consider the more subtle types of emotional disturbance, the problem of unravelling the order of failure becomes more difficult, and, as this becomes more intricate, so does it lend itself the more readily to diverse theories regarding the cause and effective treatment. We frequently have impressed upon us the importance of conflicts and repressions and buried memories, and how these, charged as they may be with emotion, may remain throughout life as a dynamic force, ready at any time to play an active part in producing or keeping up a state of mental unrest. It is impossible, as it would be imfair, to attempt to discuss the psycho-analytical claims within the limits of this paper, more especially having regard to the diverse outlooks of the different schools who employ this method. Never- theless, there is one point which becomes increas- ingly evident to me, and that is that the teaching of Freud is more valuable as a factor in education than as a basis for treatment. When I say this, I do not wish to convey the impression that I am not aware that many persons have had their symptoms reUeved by the psycho-analytical methods of treatment, but the question one is bound to put to oneself is whether the majority of these persons might not have derived the same relief from other methods with a far less expenditure of time. That there are patients whose restoration to health has been brought about by psycho-analytical methods when all other forms of treatment have failed is no doubt true, but the same can be said of almost every other method. Therefore it is incumbent upon us to try to differentiate between cases so that each may receive such treatment as experience has shown the more likely to be beneficial. All schools of thought have learnt to appreciate that the further one gets back, that is, the nearer one gets to the beginnings of a disorder, the more Ukely is the treatment to bring about a restoration to health, and one of the chief reasons for this is that in the initial stages the disturbance is simple in character and is not yet complicated by one function after another becoming upset until maybe the whole organism is involved. It is when secondary disturbances become of primary importance that Freudian methods, like all other methods, are most likely to fail, and it is of interest to note that Dr. Ernest Jones claims the best results from early cases. For myself I have long been in doubt whether repressions and forgotten conflicts are as important as the Freudian school would have us believe, and I regard emotion in its conscious stages as being the more active in bringing about mental disorder. In any case, whatever our views as to the cause, that the best results are to be obtained by early treatment goes to prove the importance of prophylactic measures. Many physical diseases have their beginnings in childhood, and this is also the case, and perhaps to a greater degree, with mental disorders. Even with our present knowledge much more might be done towards the prevention of mental disturbance by greater care in the early training of the young. The pubhc, and indeed the bulk of the medical profession, have yet to learn that the development of mental disorder is slow, and at times insidiously slow. Yet to those who know, or those who care to learn, the progress towards this end is definite and is marked by physical or mental changes which indicate what is taking place and what must ultimately result. The explaining away of early symptoms should be persistently attacked by the medical profession and the dangers which attend such a course strongly emphasised. Medical students must be taught to investigate the mental state of the patient and not merely to regard man as an organism with nothing beyond physical reactions. Recently I read an article in a medical journal on the matters to be regarded in the preparation of a patient for a surgical operation in which there was not one word regarding the mental state, nor a single consideration as to the emotional effect that the operation might have upon the individual, and yet this emotional reaction may be the factor which ultimately will decide the success or failure of the operation. It is often a very serious matter to overlook the early signs of physical disease, but it may be even more dangerous to disregard early minor mental changes. In the normal man the various attributes of the mind are so correlated that their proper working is of benefit to the whole, but if one important attribute becomes disordered, the working of the undamaged remainder now hastens the catastrophe. An example of this may be found in sensation, for our idea of self is largely dependent upon it, and if sensation becomes disordered, oiir normal equipment, ideation, memory, reasoning, and judgment may in consequence work against us and tend to bring about our intellectual down- fall. The normal and the abnormal alike rationaUse, but the latter bases his rationahsation upon some abnormal condition. A proper understanding of this is all-important, for it not only helps us to under- stand the working of the mind of the abnormal man, but it indicates to us the best way of treating him by psycho-therapeutic means. Space wiU not permit of my discussing the various methods of psycho-therapeutic treatment and their respec- tive values. Each has its place in psychological medicine, but, as I have already observed, no one method can be regarded as all-sufficing. Toxic Factors. I should like now to refer briefly to some of the more important matters on the physical side which call for consideration in the treatment of mental disturbances. The longer I work in this special branch of medicine, the more convinced do I become of the importance of the effects of toxic elements in the production of mind disorders, whether these poisons are produced within the body or acquired from without. No doubt extravagant claims have been made that all insanities, or the majority of them, are occasioned by poisons, and heroic methods have been used to counter them, with the result that more moderately minded men recoiled from investigating
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