300 PSYCHIATRY 



2. THE DETERIORATING PSYCHOSES. These psychoses have 

 an important relation with the functional psychoses, which should 

 be mentioned here. They are characterized by persistent func- 

 tional deterioration and tend to dementia; this is consistent with 

 the opposing fact that the vital energies of the life-process some- 

 times appear to overcome in recovery the interferences with their 

 normal action. It has been said that the functional psychoses tend 

 to recovery; yet the failure to recover in some cases may be con- 

 sistently referred to constitutional weakness or the loss of vigor 

 in old age. This does not imply that heredity is an essential cause 

 of mental disease; "neuropathic" persons have less endurance 

 against all adverse influences. Among the deteriorating psychoses 

 the first place is given to a large group called "dementia precox ;" 

 its general form is not clearly differentiated, nor its special divis- 

 ions; no common basis is implied in the designations hebephrenia 

 (mental weakness), katatonia (motility disorders), paranoid forms 

 (insistent and imperative conceptions). A single case may change 

 from one "form" to another, and the recognition of some con- 

 stant characters is required to unify all the "forms;" the com- 

 mon fact of dementia is shown in the deterioration of capacity 

 that may occur in any of the functional mental elements, varied 

 in different cases; this implies structural changes. The character 

 of the failure is revealed in the quiescent states after the subsid- 

 ence of active symptoms. The most common fact is the deep-seated 

 deterioration of the emotional nature; hence the characteristic 

 indifference and apathy which favors the development of habit 

 automatisms, etc. Concerning this large group of deteriorating 

 psychoses, regarded as above stated, and including also the few 

 other "disease-forms" at present accepted as such, some general 

 conclusions now appear with respect to the functional psychoses. 



Mental Physiology and the Functional Psychoses, continued 



The unification of the functional psychoses can only be indi- 

 cated here with respect to the explanations and conclusions reached 

 during some years of teaching the principle that each of the groups 

 conveniently designated neurasthenia, melancholia, mania, etc., 

 simply includes variations in combinations of different degrees of 

 functional disorder of the same physical and mental elements. 

 The essential unity of melancholia and mania was recognized by 

 Griesinger and others with differing explanations; modern physi- 

 ology and psychology broaden and simplify the whole subject 

 with better explanations of general principles. 



In recent psychiatry there is an evident tendency to the unifica- 

 tion of the psychoses. 



