PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 297 



and therefore in pathological conditions the emotional tone of the 

 psychical sphere corresponds with the sense of personality by "states 

 of mental depression" (melancholia) associated with malaise and 

 ill-being, and "states of mental exaltation" (mania) with sense of 

 well-being and false euphoria. The complex sources of the sense 

 of body have been described and the changes of irritability due to 

 fatigue and other causes; the consequent variations of the sense of 

 physical pleasure and pain are closely connected with the rise and 

 decline of irritability, its intensifications and losses, but not with 

 parallel changes. 



In the emotional states of "neurasthenia" the depression is 

 variable; of "melancholia," persistent; in both the feeling-tone 

 may be combined in various ways with the first degree of functional 

 deterioration of irritability marked by agitation, restlessness, 

 "irritable weakness" (psycho-motor excitation), or by dullness, 

 slowness, languor (psycho-motor retardation). In nervous exhaus- 

 tion and melancholia the feeling-tone is constantly influenced by 

 bluntings and losses of organic sensation, strikingly shown in the 

 loss of the sense of fatigue "fatigue-anesthesia," and the various 

 unequally distributed conditions described in the natural order of 

 decline as hyperesthesia, hypoesthesia, paresthesia, and anesthesia; 

 also ease and obstruction of motor expression have their reflex in- 

 fluence upon the affective states as in a feeling of facility, or the 

 "sense of inadequacy" and the "sense of effort." 1 Hopelessness, 

 introspection, retrospection, apprehension, self-reproach, are logical 

 consequences. All these variations are persistent intensifications 

 and differences of the normal connections of ideas and emotions, 

 with their correlated physical reactions; the persistence of morbid 

 emotional reactions indicates deteriorated body-states. 



In the emotional states of "mania" there is the characteristic ex- 

 altation and exhilaration ; but in many cases there is depression of 

 feeling of the type shown by anger in its origin from painful states 

 of irritation, and by distressing delusions and aggressiveness. These 

 two prominent types of feeling-tone are associated with corre- 

 sponding variations of irritability marked by its rise from moderate 

 to high degrees of psycho-motor excitation, shown mentally in 

 "flight of ideas," corresponding to the agitation and irritable weak- 

 nesses in melancholia, sometimes more extreme and sometimes 

 reduced and lost. -The clinical pictures in some cases may indicate 

 a simple absence of painful irritation, but they certainly show, char- 

 acteristically, the false euphoria of blunted sensations, as in alco- 

 holic intoxication. 



(2) Intellect. (Sensations perceptions and ideas.) The "think- 

 ing process," as it is rather vaguely called, may be definitely con- 

 * Cf. Cowles, E., op. cit., Neurasthenia and its Mental Symptoms, 1891. 



