The Excitable
The Unstable
The Impulsive
The Eccentric
The Liar and Swindler
The Antisocial
The Quarrelsome
17. Defective Mental Development (oligophrenia)
At the annual meeting of the American Medico-Psychological Association in 1869 Nichols called attention to the statistical studies proposed by the International Congress of Alienists in 1867. As a result of his efforts a series of twenty-one statistical tables was prepared and used unofficially for several years, although never formally adopted. A committee reported again on this subject in 1896, but without any definite action being taken. The Italian psychiatrists have had a classification which has been in general use by them for some time. Interest in this subject has been stimulated by the frequent publications of Kraepelin during the last thirty years. Meyer and Hoch have been largely responsible for bringing his work to the attention of the profession in this country, and Kraepelin's classification with some modifications has come into very general use here. It was not until the publication of its twenty-first annual report in 1909 that the New York State Commission in Lunacy adopted a modern classification of psychoses.
At that time there were practically as many different forms of statistical reports in the United States as there were hospitals. In the meanwhile almost every textbook published during the last fifty years has announced a new classification of mental diseases. They have been based on etiology, pathology, symptomatology and psychology. English, French, German, Italian and American classifications have appeared, each representing, as a rule, different schools of psychiatry. Kempf[143] would discard the term psychosis altogether and speak only of neuroses as "more consistent with the integrative functions of the nervous system." For diagnostic purposes he proposes to separate the benign from the pernicious processes and classify them according to their psychological mechanisms as suppression, repression, compensatory, regression and dissociation neuroses. The easiest way out of all these difficulties, as Southard[144] has said, would be "to deny the existence of entities in mental disease. There are two forms of this contention; first, that mental disease is nothing more or less than insanity, an entity itself, a genus with but one species, or secondly, that all victims of mental disease are individually to be provided with entities, that is, all examples of mental disease are sui generis. The development of psychiatry has killed the former contention stone dead, but the latter contention still flourishes to an extent among those who overstress the individual factor. And this latter contention is bolstered up by the existence of so many psychopathic patients of whom a diagnosis cannot be rendered for practical or theoretical reasons. However, there are no really consistent advocates of the sui generis plan of classification." It is interesting to note that he concedes ... "that the American Medico-Psychological Association's classification, adopted as it has been by a great number of American institutions and by the United States Government for war purposes, is a reasonably good classification and aware that its constituent elements fairly well correspond with what all American psychiatrists agree upon."
Southard[145] raises the question as to how this classification can be used for diagnostic purposes. He answers this query by suggesting "A key to the practical grouping of mental diseases"[146] ... "to be followed, when necessary, like a botanical key in the search for the classification of a plant."... "It is a key to study and not an analytical classification with any pretence to finality."... "The plan is not so much an excursion into nosology as an essay in the technique of psychiatric diagnosis for the tyro."
The problem presenting itself in the adoption of a classification purely for statistical purposes was not a question of a scientific grouping of the psychoses based on either etiological, anatomical, pathological, clinical or prognostic considerations. It was a question of compiling a tabulation or list of clinical entities recognized generally by American psychiatrists, subject to such changes and modifications as may be necessary to make it conform to accepted standards. As a matter of fact, no adequate reason for a classification of mental diseases for any other than statistical purposes has even been advanced by the authors of our textbooks on psychiatry. They do not contribute anything of value whatever to our knowledge of symptomatology, diagnosis or treatment. Practically the only point on which the writers of our textbooks agree is that there is no one fundamental principle upon which a satisfactory classification can be based. It is unfortunate that tradition seems to demand the serious consideration of a problem which many believe admits of no solution and which would mean little or nothing to the future of psychiatry if it were solved. The views of the Committee on Statistics are shown by a quotation from the report made to the Association at its meeting in New York in 1917:—"Your Committee feels that the first essential of a uniform system of statistics in hospitals for the insane is a generally recognized nomenclature of mental diseases. The present condition with respect to the classification of mental diseases is chaotic. Some states use no well-defined classification. In others the classifications used are similar in many respects but differ enough to prevent accurate comparisons. Some states have adopted a uniform system, while others leave the matter entirely to the individual hospitals. This condition of affairs discredits the science of psychiatry and reflects unfavorably upon our Association, which should serve as a correlating and standardizing agency for the whole country. The large task of your Committee therefore has been the formulation of a classification which it could unanimously recommend for adoption by the Association. The task was accomplished only after several prolonged conferences at which classifications now in use in various states and countries, and the recommendations of leading psychiatrists were considered. The classification finally adopted is simple, comprehensive and complete; it copies no other classification but includes the strong features of many others; it meets the demands of the best modern psychiatry but does not slavishly follow any single system. In short, your Committee has endeavored to formulate a classification that could be easily used in every hospital for the insane in this country and that would meet the scientific demands of the present day."
Since the compilation of statistical data relating to the various activities of the hospitals for mental diseases in this country was definitely decided upon by the Association at its meeting in 1913, the membership of the Committee on Statistics has from time to time included the following:—Dr. Thomas W. Salmon, Medical Director, National Committee for Mental Hygiene; Dr. Owen Copp, Physician in Chief and Superintendent, Pennsylvania Hospital, Department for Nervous and Mental Diseases; Dr. E. Stanley Abbot, Medical Director, Public Charities Association of Pennsylvania; Dr. Henry A. Cotton, Medical Director, New Jersey State Hospital, Trenton; Dr. L. Vernon Briggs, Boston, former member of the Massachusetts State Board of Insanity; Dr. Adolf Meyer, Professor of Psychiatry, Johns Hopkins University; Dr. Albert M. Barrett, Professor of Psychiatry and Neurology, University of Michigan; Dr. George H. Kirby, Director of the Psychiatric Institute, New York City; Dr. Samuel T. Orton, Professor of Psychiatry and Director of the Psychopathic Hospital, University of Iowa; Dr. Frankwood E. Williams, Associate Medical Director, National Committee for Mental Hygiene; Dr. Elmer E. Southard, Director of the Massachusetts State Psychiatric Institute; Dr. C. Macfie Campbell, Director of the Boston Psychopathic Hospital, and the writer. Associated with the committee officially were: Dr. August Hoch, formerly Director of the Psychiatric Institute, New York; Dr. H. M. Pollock, Statistician of the New York State Hospital Commission; Miss Edith M. Furbush, Statistician of the National Committee for Mental Hygiene, and various others.
The Association's classification of mental diseases at this time (1921) is as follows:
1. Traumatic psychoses:
(a) Traumatic delirium
(b) Traumatic constitution
(c) Post-traumatic mental enfeeblement (dementia)
(d) Other types