344 READINGS IN BIOLOGICAL SCIENCE 



disorder have not so favorable a prognosis as have others, and although in 

 general mental disorders tend to take somewhat longer for their cure than 

 do the disorders which take patients to general hospitals. Most readers will 

 probably be astonished to learn that during the year 1933 for every one 

 hundred patients admitted there were forty-six discharged, of which 

 number thirty-nine were considered recovered or improved. Of those dis- 

 charged 22 per cent, had been hospitalized for two months or less, 55 per 

 cent, for less than six months, 74 per cent, for less than one year, and 87 per 

 cent, for less than two years. Furthermore, it has been found that at the end 

 of ten years over one half of the patients discharged are living in the com- 

 munity, a small proportion of them, to be sure, having had in the interval 

 one or more readmissions to mental hospitals. 



It should be understood that mental disease is not a unitary thing; there 

 are many different types, some of which occur early in Hfe, some in middle 

 age and some in advanced years. The discharge rate and the prospects for 

 these various types are not all alike by any means. This is true likewise of 

 the symptomatology. The average citizen probably thinks of the mentally 

 disordered person in the terms of a "raving maniac," one who is disturbed, 

 noisy, disheveled, annoying others, possibly even making homicidal at- 

 tacks, and so on. As a matter of fact, patients of this type constitute per- 

 haps not over 5 per cent, of the population of a mental hospital. Some pa- 

 tients are depressed, some are confused, some are apathetic, many show 

 relatively little disorder of conduct. Some of this difficulty is perhaps due 

 to the legalistic notion that a person is either sane or insane, and to the 

 rather fixed definitions most of them entirely out of line with psychiatric 

 thought, which the law gives for that legal term "insanity." Mental disorder 

 represents a failure of the individual to adjust to his environment, but such 

 adjustment depends on many things: it depends upon his heredity and 

 the constitution with which he was born, on his training, on the function- 

 ing of his ductless glands, on the situation with which he is confronted, 

 his education, his native endowment and many other factors. In some in- 

 stances we have degenerative processes due to old age, in others we have 

 brain disease due to infection or intoxication, and it is quite obvious that 

 with so many varying factors the types of reaction and the manner in 

 which adjustment fails will vary. Mental disorder is not necessarily accom- 

 panied by disease of the brain, although brain damage often produces men- 

 tal symptoms. It is rather a failure of adjustment of the entire personality. 

 "Mind" is not a unit, but rather an abstraction which symbolizes the sum 

 total of the reactions of the individual at the social level. 



A few words may be in order concerning some of the broader general 

 types of mental disorder which find their way into hospitals. One of the 

 important groups is that due to degenerative processes, that is, hardening 

 of the arteries of the brain (cerebral arteriosclerosis) and senility. By the 

 very nature of the disorder, the outlook is poor. Together these types make 



