PSYCHIATRY IN THE FUNCTIONAL PSYCHOSES 301 



A significant contribution has been made by Dana; 1 in his large 

 neurological experience he has seen much to favor the idea that 

 most neurasthenias are mental cases, or non-insane psychoses; 

 the term phrenasthenia is used for a special group of neurasthenic 

 or degenerative psychoses including mainly those described by 

 Janet as psychasthenia; it is said that an innate constitutional 

 weakness underlies all the chief non-accidental functional insan- 

 ities. There is much reason for a simplifying psychiatrical con- 

 ception, complementary to Dana's view, that not only most but 

 all functional mental cases are subjects of asthenic reduction of 

 functional efficiency and are neurasthenic. The tendency is not- 

 able in the remarkable studies of Janet in which he reaches the 

 conclusion by psychological analysis that many of the apparently 

 diverse psycho-neuroses may be unified under the one principle of 

 psychasthenia; this implies a general and special insufficiency in all 

 the phenomena and is at the same time neurasthenia; these affec- 

 tions represent regular degrees of lowering of functional efficiency. 



The genetic method leads to a comprehensive view of all the 

 psycho-neuroses. Considered biologically and physiologically neur- 

 asthenia, phrenasthenia, psychasthenia and all the functional psych- 

 oses are modifications of functional characters. Whether these 

 modifications were acquired newly by the individual himself, or 

 by his ancestor and thereafter transmitted as though they were 

 inherent variations, the problem is essentially the same. However 

 perverted, distorted, and anomalous the functional phenomena 

 of vital activity may be, they must be traced back to the first 

 interferences with the physiological elements to find their explana- 

 tions in their genesis. We may assume that all normal adult indi- 

 viduals are subject to certain acquirable functional modifications 

 numerous and complex, thus forming the symptom-groups 

 called neurasthenia, melancholia, and mania, for example; all ab- 

 normal persons are subject not only to the same changes, but to 

 something more and something different, and these additions may 

 be simply special variations of intensity, or degrees of impairment, 

 or of differences pointing to other than functional explanations. 

 A general principle in mental pathology may be derived from these 

 considerations. Whatever the form of a deteriorating psychosis, 

 it has its own pathological characters; but superimposed upon 

 these symptom-factors, and relatively superficial, neurasthenic 

 manifestations commonly appear, and there may be episodes, more 

 or less transitory, of manifestations of the functional psychoses. 

 This occurs notably in the early stages of dementia precox and 

 manifests the practical concurrence of two diseases, viz., the per- 



1 Dana, C. L., The Partial Passing of Neurasthenia, Boston Med. and Surg. 

 Jour., vol. CL, 1904. 



