FACTORS IN MENTAL HEALTH AND ILLNESS 575 



curiously preserved in cerebral syphilis; also comparatively well in the 

 depressions. The preservation of clearness as opposed to clouding of 

 consciousness is especially noteworthy in dementia precox, confusion 

 is most prominent in infective, exhaustive and toxic conditions. Many 

 cases of dementia precox have all the originality of Alice's White 

 Knight; and the catatonic with his floor-polisher surpasses in perse- 

 verance. The most striking abnomalies with Aussage experiments 

 would probably be met in the Korsakoff psychosis. 



It is obvious that, in any social sense, leadership and independent 

 efficiency are practically wiped out in the mental diseases we have dis- 

 cussed. The fact that as a group they must be removed from society 

 sufficiently attests this, though in many cases a diminished capacity for 

 work under direction is preserved. But to this rule there are important 

 exceptions, which fall into three classes. In spite of real suffering from 

 neurosis or psychosis, special aptitudes enable some persons to main- 

 tain themselves independently, and even to perform valuable service in 

 a highly organized society. Most neurologists number such individuals 

 among their patients. In a second group of cases there is a clearer 

 connection between the greater efficiency and the immediate symptoms 

 of the psychosis. There are two types of these. Mild cases of manic 

 excitement derive therefrom an energy which, if only the judgment be 

 enough preserved, enables them to do tremendous amounts of work, 

 bear troubles, and carry off situations that would be impossible to them 

 in their normal states. I have often quoted a case of alternating ex- 

 citements and depressions who used his excitements to earn enough 

 money to tide over his depressions in private hospitals. This hypo- 

 manic state may be constitutional, giving energy and capacity far sur- 

 passing that of normal men, but complicated with pathological features. 

 The personality of Alexander the Great, with its stupendous accomplish- 

 ment, its egotism and its excesses, is a distinct historical example. 

 The other of these types of effectiveness results through paranoic rather 

 than manic traits. Paranoia carries with it a faith, singleness of pur- 

 pose, persistence and self-confidence greatly in advance of normal per- 

 sonality, but these regularly attach to ideas whose working out throws 

 that individual permanently out of adjustment with the social order. 

 But if the ideas are such as to arouse social response, great leaders are 

 produced. In the religious sphere it is evident that strong personalities 

 may found systems of belief which, not to mention the occasional 

 amassing of worldly goods, attract many followers, and are genuine 

 moral forces, with no other support than their autistic convictions and 

 indomitable zeal. The inspiring power of such characters in secular 

 history is fitly represented by Joan of Arc. 



Lastly, we may take up the question of the general cohesion in the 

 different elements of the personality. As one may gather from the late 



