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types of insanity. Depressed patients frequently manifest the delusion that they have committed a great sin, and are unfit to associate with anyone. Excited and maniacal patients often believe they are important personages-kings or queens, old historical celebrities, etc. Paranoiacs commonly have delusions of persecution and of a conspiracy among their relatives or their associates or rivals. Victims of alcoholic insanity have delusions regarding sexual matters, and generally charge with infidelity those to whom they are married. General paretics in most cases have delusions of grandeur; that is, false ideas of great strength, wealth, political power, beauty, etc.

The emotion which accompanies mental activity is generally exaggerated in all insane people except the demented. One sees extreme depression, or undue elation and exaltation, or silly glee and absurd joy. Intensity of emotion is frequent.

Crimes Impulsively Committed by the Insane

An interesting mental feature of many insane patients is the imperative conception, or imperative impulse. This is a strong urging felt by the patient to commit a certain act. He may know the act is wrong and dread the punishment which he expects will follow its commission. But so constantly and strongly is he impelled that he finally yields and commits the act. Crimes are thus perpetrated by the insane, with a full

knowledge of their enormity. The fact that such impulses undoubtedly exist should modify the common test, as to an insane person's responsibility before the law. The statute in many countries regards an insane criminal as responsib's act, if he knows the difference between right and wrong. This decision is unjust and the basis is wrong; for an impulse may be overwhelming, and the patient utterly helpless during its continuance. However, a patient who has committed a crime under stress of such an irresistible impulse should be put under permanent custodial care.

Physical Signs of Insanity

The physician who is skilled in psychiatry finds in very many insane patients marked physical signs. There are pains, insensitive areas, hypersensitive areas, changes in the pupils of the eyes, unrestrained reflex action, and partial loss of muscular control, as shown in talking, walking, and writing. Constipation and insomnia are very early symptoms of disease in a very large proportion of the insane.

It is productive of no good result for a layman to try to classify the insane. The matter of classification will be for several years in a condition of developmental change. It is enough to speak of the patient as depressed or excited, agitated or stupid, talkative or mute, homicidal, suicidal, neglectful, uncleanly in personal habits, etc.

Illustrations of Various Types

There are very interesting features connected with typical instances of several varieties of insanity, as they were noted in certain cases under the writer's care. A depressed patient with suicidal tendencies cherished the delusion that war with Great Britain was imminent, and that in such an event British troops would be landed on Long Island between New York City and the spot where he conceived the cattle to be kept. This, he argued, would cut off the beef and milk supply from the city. He therefore decided to do his part toward husbanding the present supply of food by refusing to eat; an act which necessitated feeding him through a rubber tube for many weeks. He also attempted suicide by drowning, throwing himself face downward in a shallow swamp, whence he was rescued. This young man was an expert chess player even during his attack.

A maniacal patient wore on her head a tent of newspaper to keep the devil from coming through the ceiling and attacking her. She frequently heard her husband running about the upper floor with the devil on his back. As a further precaution she stained her gray hair red with pickled beet juice, and would occasionally hurl loose furniture at the walls and ceilings of her rooms and assault all who approached her.

A man who presented a case of dementia pulled the hairs from his beard and planted them in rows in the garden, watering them daily, and showing much aston

ishment that they did not grow. He spent hours each day in spelling words backward and forward, and also by repeating their letters in the order in which they appear in the alphabet. When he wanted funds he signed yellow fallen leaves with a needle, and they turned into money.

A case of general paresis (commonly though improperly called "softening of the brain ") passed into the second stage as a delusion was uppermost to the effect that there was opium everywhere; opium in his hat, opium in his newspaper, opium in his bath sponge, opium in his food. He thereupon refused to eat, and was fed with a tube for two years, at the end of which time he resumed natural methods of nutrition and ate voraciously. Another general paretic promised to his physician such gifts as an ivory vest with diamond buttons, boasted of his great strength while scarcely able to walk alone, and declared he was a celebrated vocalist, while his lips and tongue were so tremulous he could scarcely articulate.

Fixed Delusions of Paranoia

Paranoia is an infrequent variety of insanity in which the patient is dominated by certain fixed delusions, while for a long time his intellect is but slightly impaired. The delusions are usually persecutory, and the patient alleges a conspiracy. He is generally deluded with the belief that he is a prominent person in

history, or an Old Testament worthy, and there is usually a religious tinge to his delusions. A patient of the writer believed himself to be the reincarnation of Christ, appearing as "the Christ of the Jews and the Christ of the Christians" in one. Over the head of his landlord, who requested overdue rent, the patient fired a revolver, "to show that the reign of peace had begun in the world." He wrote a new bible for his followers, and arranged for a triumphal procession headed by his brother and himself on horseback, wearing white stars.

How the Physician Should Be Aided

When there is a suspicion of irrationality in a person's conduct, and certain acts or speeches suggest insanity, the whole surroundings and the past life must be considered. Frequently when the eyes are once opened to the fact of insanity, a whole chapter of corroborating peculiarities can be recalled. It is wise to recall as many of these circumstances as possible and note them in order as they occurred, for the use of the physician. Strikingly eccentric letters should be saved. Odd arrangement of clothes, or the collecting of useless articles, should be noted in writing. Changes in character, alteration in ideas of propriety, changes in disposition, business or social habits, and great variation in the bodily health should be noted in writing. Delusions hallucinations, and illusions should be reported in full.

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