"(a) Epileptic deterioration: A gradual development of mental dullness, slowness of association and thinking, impairment of memory, irritability or apathy.
"(b) Epileptic clouded states: Usually in the form of dazed reactions with deep confusion, bewilderment and anxiety or excitements with hallucinations, fears and violent outbreaks; instead of fear there may be ecstatic moods with religious exaltation.
"(c) Other epileptic types (to be specified)."
During a period of sixteen years in the New York state hospitals (ending October 1, 1888) 3,167 of 84,152 admissions were cases of "epilepsy with insanity." This meant an admission rate of 3.76 per cent. It must be borne in mind, however, that the differentiation between epilepsy with insanity and psychoses clearly due to epilepsy was not attempted at that time. During a subsequent period of eight years in the same institutions, when what is essentially the present classification was in use, the admission rate for epileptic psychoses was 2.42 per cent. In 1919 with 3,011 first admissions to the Massachusetts state hospitals only fifty cases (1.66 per cent) were reported as showing psychoses due to epilepsy. Six hundred and twelve cases, constituting 3.33 per cent of 18,336 first admissions, were reported by twenty-one hospitals in other states. An analysis of a total of 70,987 first admissions in forty-eight state hospitals therefore showed that 1,865, or 2.62 per cent, were epileptic psychoses. After reading the statements contained in various textbooks regarding the extraordinary frequency of epileptiform seizures in dementia praecox, it is difficult to escape the conclusion that the percentage of epileptics has been underestimated rather than exaggerated.
CHAPTER XVI
THE PSYCHONEUROSES AND NEUROSES
The words neurosis, psychosis and psychoneurosis are of obscure origin and have had a varied significance from time to time. Murray[332] defines psychosis as a psychological term indicating "a change in the psychic state; an activity or movement of the psychic organism, as distinguished from neurosis" which he speaks of as a "change in the nerve-cells of the brain prior to, and resulting in, psychic activity." Huxley in discussing this subject in 1871 made the following differentiation: "In all intellectual operations we have to distinguish two sets of successive changes—one in the physical basis of consciousness and the other in consciousness itself; one set which may, and doubtless will, in course of time, be followed through all its complexities by the anatomist and the physicist, and one of which only the man can have immediate knowledge. As it is very necessary to keep a clear distinction between these two processes, let the one be called neurosis and the other psychosis."
Von Feuchtersleben used the latter word in its present psychiatric significance in his "Lehrbuch der Aertzlichen Seelenkunde" in 1845. Its repeated appearance in the first volume of the Allgemeine a Zeitschrift für Psychiatrie in 1844 would strongly suggest a frequent use of the term in the German psychiatry of that day. It was unknown in English works until quite recently, although the word is found in Maudsley's "Responsibility in Mental Diseases" (1874)—"No wonder that the criminal psychosis which is the mental side of the neurosis, is for the most part an intractable malady, punishment being of no avail to produce reformation." Lewes, in "The Problems of Life and Mind" published after his death in 1879, makes a very significant remark: "Pathologists call it a psychosis, as if it were a lesion of the unknown psyche." Clouston's 1911 edition makes no reference to psychoneuroses as such.
The word neurosis has been much more extensively employed in medical literature. William Cullen, a well-known professor in the University of Edinburgh, in his "First Lines of the Practice of Physic" in 1774, said: "I propose to comprehend, under the title of neuroses, all those preternatural affections of sense or motion which are without pyrexia, as a part of the primary disease." In his "Synopsis Nosologicae Medicae" in 1785 he divided diseases into four general classes: Pyrexia or febrile diseases; neuroses or nervous diseases, as epilepsy; cachexiae or diseases resulting from bad habit of the body, as scurvy; and locales, or local disease, as cancer. Brachet,[333] who was one of the earlier writers on the subject of hysteria, defined that disease in the following words in 1847: "Hysteria is a neurosis of the cerebral nervous system, which manifests itself more or less brusquely by crises of general chronic convulsions and by the sensation of a globe ascending in the course of the oesophagus, at the upper extremity of which it becomes fixed, causing there a menace of suffocation." Briquet, another French writer, expressed somewhat similar views in 1859. The word neurosis as now used may be said to refer to a functional disturbance of the nervous system, which, if directly due to etiological mental factors, is spoken of as a psychoneuroses.