FACTORS IN MENTAL HEALTH AND ILLNESS 579 



up as the shut-in personality. In the time at my disposal the concep- 

 tion can not be fully discussed. The characteristic picture, however, 

 is one of repression, seclusiveness, secretiveness, failure of normal 

 "participation in cares, pleasures and pursuits" of others, self-centered 

 stubbornness as contrasted with aggressive persistence, special oddities 

 of conduct, the so-called "in-growing conscience," strong religious or 

 mystical trends, with relative emphasis of passive virtues. A concrete 

 example is described in the following words : 



As a child he was precocious but in school had to study hard. He lacked 

 confidence, was pessimistic, brooding and egotistical in disposition. He pre- 

 ferred reading to athletic sports, and gave religious scruples as a reason for not 

 attending the theater. He did not use alcohol, tobacco, tea or coffee, and it was 

 also noted that he did not care to associate with the opposite sex. At the age of 

 17 he began work as a clerk and was steady, honest and exact. . . . 



The manic-depressive group shows a larger number of cases where 

 abnormal traits are not seen before the psychosis, and the shut-in traits 

 are nearly absent. But as an elementary point here it is brought out 

 in some recent figures of Hoch's that persons who develop manic- 

 depressive psychoses have also shown special tendency to exaggerated 

 emotional reactions in their normal lives. These may be of either a 

 euphoric or a depressive nature ; when they are euphoric the individuals 

 are more likely to have manic attacks, when they are depressive to have 

 depressive attacks; and the melancholic personalities, manic ones. The 

 apparent influence of the personality on the form of the attack dimin- 

 ishes to zero as the difference between the cheerfulness and depression 

 of spirits in health becomes less marked. 



In dementia precox the psychotic mode of adjustment is regularly 

 adhered to; in other words, the psychosis is not recoverable. The 

 manic-depressive states, whose picture is as a whole much less detached 

 from reality, represent rather a temporary mode of adjustment; that is, 

 the psychosis is recoverable. The manic-depressive psychosis makes for 

 any port in a storm ; dementia prcecox scuttles the ship. 



Both conditions, however, with paranoia, and in a more circum- 

 scribed way the neuroses, show definite and systematic effort of adapta- 

 tion to the patient's life-circumstances. The final understanding of 

 these cases is given in the questions, " Why did you have to have this 

 thing ? " what made this adjustment a necessary one for the patient? and 

 what needs must now be met in a more normal way, what particular 

 danger points must be guarded, what false views of life corrected ? 



It is now apparent, I hope, that the mental criterion of psychosis is 

 essentially one of mental maladjustment to the surroundings, and often 

 it is the only criterion, mental or physical. The individual differences 

 that distinguish psychotic and normal personalities are not so much 

 differences in motor power, sensory acuity, affectivity or intellect, but 



