298 PSYCHIATRY 



ceived to include the ideational reactions of the stream of conscious- 

 ness, constituted of the association-processes in combination with 

 the inhibitory or exciting control of the will working through atten- 

 tion and apperception; the emotional factor enters into the com- 

 bination and modifies the "thinking process" with intensifications 

 of interest and motive influences. It is impossible to describe 

 these function-factors separately because they all work together. 

 The character of the ideas the sensations revived by memory 

 in the association-process, whether depressed in melancholia, or 

 exalted in mania, is in harmony with the emotional tone as it is 

 "lowered" or "exalted." The time-element in the processes of the 

 stream of consciousness varies with the rise in irritability and 

 especially with the coincident reduction of inhibition. This, in mania, 

 with the intensification due to irritability, produces "flight of ideas" 

 with quick reactions and superficial associations. The tendency is to 

 increasing weakness, reduction of clearness, incoherence, and final 

 arrest of mental functions in confusion or stupor. With disordered 

 perceptions there are illusions and hallucinations; delusions arise. 

 Maniacal states represent graver degrees of derangement than 

 melancholia, and a lower level of functional reduction, especially 

 of inhibition. The more profound conditions of acute exhaustion 

 (confusional insanity, exhaustion psychosis) occur sharply by 

 themselves from strongly exhausting influences and are varied mani- 

 festations of delirium; these may supervene in the severer types of 

 both melancholia and mania. 



(3) Will. (Inhibition attention and apperception.) In the 

 sense that acts of the will are such acts only as cannot be inatten- 

 tively performed it produces exciting or augmenting effects in the 

 "thinking process," or inhibiting effects; working through attention 

 and apperception its function of control appears in voluntary inhibi- 

 tion, and this has been described in part in connection with the other 

 elementary functions and in the reference to the physiological law of 

 inhibition. Normally inhibition, both physiological and voluntary, 

 stands in mobile equilibrium with the tendency of all conscious and 

 neural excitations to discharge into motor effects, open or concealed 

 within the organism. In the incessant change and succession in the 

 train of ideas in consciousness the attention holds the chosen or 

 attracting idea in the interplay of neural processes and thus inhibits 

 its tendency to pass away, other items being held with it in reason- 

 ing, and apperception being a special form of the same controlling 

 influence. This inhibitory function is a true index of the integrity of 

 vital energy; it is regularly reduced in efficiency with asthenic 

 reduction of the nervous forces. Voluntary inhibition is variably 

 reduced in neurasthenia, persistently in melancholia, and greatly so 

 in mania with loss in delirium. 



