PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 295 



"clinical type" to another, down to the lowest degrees of vital energy 

 and complete loss of voluntary function. Throughout all observa- 

 tions of these changes the essential principle of variations of irrita- 

 bility is never to be lost sight of nor the fact that the first step toward 

 deterioration of function is characterized by a rise of irritability. 

 Another pervading principle is that among the multiple functional 

 mechanisms failure of energy is unequal, and that changes and losses 

 of irritability must apply as much to sensory as to motor function. 

 The word "psychosis" can be used most profitably as correlative 

 with "neurosis," and as including both its proper psychological and 

 pathological meanings, leaving the differentiations of sanity and 

 insanity to be indicated by those words. A basis of inquiry, as above 

 described, prepares the way for the examination that comes first in 

 order of the initial departures from mental integrity, viz., the 

 affections called imperative and fixed ideas, and the primary asthenic 

 conditions of neurasthenia before the after-effects of chronic states 

 have supervened. 



Insistent and fixed ideas refer to a wide range of kindred cases of 

 affections that can happen to sound minds in persons neither tem- 

 porarily nor constitutionally neurasthenic. The functional elements 

 are normal and the affections may attain characteristic forms in 

 normal minds; but this happens to them more readily when there is 

 neurasthenic reduction of inhibitory energy and greater degrees of 

 intensity and persistence occur in association with constitutional in- 

 stability. All observant sane persons estimate the purposes of others 

 by interpretations of their speech and behavior, and thereto fittingly 

 adapt their own conduct influenced by inferences and judgments in 

 a manner that would indicate "paranoid" suspicion under certain 

 circumstances. Inasmuch as this is a universal, functional, self- 

 protective principle, sane persons have normally the functional 

 disposition to produce ideas of suspicion and persecution, but well- 

 balanced minds control thought and speech. In any psychosis, how- 

 ever, associated with asthenic conditions there may be "paranoid 

 forms" not belonging to that psychosis as essential to the symptom- 

 complex; this reaction is liable to become casually intensified or 

 further developed and fixed by habit. In many cases not "psych- 

 asthenic," nor physically neurasthenic, the affection is purely a 

 functional accident; it may involve all forms of emotional reactions, 

 other than "phobias," and many cases recover. 



Neurasthenia, in its early conditions, uncomplicated by the effects 

 of habit, presents the same elements, in mild degrees of functional 

 reduction, that characterize their greatly varied combinations in the 

 symptom-complexes of the graver conditions of melancholia, mania, 

 and exhaustion psychosis or confusional insanity. These neuras- 

 thenic conditions may occur in all persons, under sufficient stress, 



