n8 THE FEEBLY INHIBITED. 



tain families there is an inherited impulse to a particular suicidal act, 

 in other cases the impulse is less specific. Nevertheless, it is to be 

 noted that the common forms of suicide are rather few, namely, 

 "drowning, hanging, firearms, wounds, poisoning, falls from a height, 

 and asphyxia" (Morselli, 1882, p. 314), and, therefore, it would not 

 be strange to find 2 or 3 members of a family by chance choosing the 

 same mode (as two unrelated members have chosen it) . Also a knowl- 

 edge of the method of suicide in one member may act suggestively upon 

 another. Still, we can not overlook the fact that 6 hangings in one 

 family in the direct line, 3 cases of impulsions to cut the throat in each 

 of two other families, a case of mother and son who drink carbolic acid 

 at the same age a quarter of a century apart in time, and the case 

 given by Hammond (described above) can not be chance merely; and 

 a present suicide is not influenced by the conscious memory of one that 

 occurred a generation or two ago. It is probable either that the choice 

 is determined by the resurrection of a repressed memory or that there 

 is an hereditary bias toward one form of self-destruction. Thus, 

 hyperkinetics are more apt to use any means which is near at hand, 

 and which is often inadequate, such as jumping out of the window or 

 choking with a string; while hypokinetics use methods which require 

 greater deliberation and are usually effective, such as shooting and 

 hanging. 



X. REMARKS ON THE CATEGORIES OF FUNCTIONAL INSANITY. 



As we have seen, psychiatrists are prone to speak of mental troubles 

 not only of the "organic" type but also of the functional, as diseases. 

 And, though there have not been wanting those who have warned 

 against this view, it seems to be current practice to so regard them. 

 We note the great importance laid in the staff meetings of State hos- 

 pitals upon diagnosis. Yet a study of hospital records shows, first, 

 that a large proportion of patients do not fit either of the main func- 

 tional types; so that the diagnosis is given, for instance, as dementia 

 precox with melancholia. On one occasion when I was invited to 

 attend a staff meeting of a State hospital, not one of the 6 cases of 

 functional insanity that was presented clearly belonged to either of 

 the two types of functional insanity. Again, it is not uncommon to 

 find that a patient who is admitted a second or third time to a State 

 hospital has received a different diagnosis each time. Now, where 

 there is so much doubt as to how the "diseases " are to be differentiated, 

 it is fair to doubt if they are entities. Indeed the conclusion is forced 

 upon one that we are dealing with complexes of behavior, with syn- 

 dromes. 



Not only are the functional insanities not disease entities, but it is 

 fair to doubt if the term "disease" is properly applied to them. Dis- 

 ordered, incompatible with the highest requirements of organized 



