INSANITY. 647 INSANITY. sufficient motive causes action, because of im- paired inlellucluul power, or impaired memory, or sub-consciousness. Consciousness is impaired; external objects are often ignored; changes of personality occur. Besides these mental signs of insanity, there are many somatic, or jjUysical, symptoms. The.se are generally divided into five classes: (1) Sen- sory symptoms, such as pain, hypersesthesia (q.v.),'or ana'sthesia (q.v.). (2) Changes in lellcx action, from disease or other cause, such as lessened knee-jerk (q.v.) or dilated pupils. (3) Motor disturbances, such as loss of muscular control, shown in altered handwriting, altered speech, gait, attitude, etc.; convulsions or paralysis may also occur. (4) Changes in cir- ■culation and nutrition, such as pallor or flush- ing, loss of flesh, impaired digestion. (5) Dis- turbances of sleep, which occur commonly. The study of disease affecting the mind is called alienism, or psychiatry, less often (in Great Uritain) medico-psycliology. The spe- cialists who give their attention to insanity and the treatment of the insane are called alienists. An accurate classification of diseases affecting the mind is difficult. Various alienists have pro- duced difl'erent tables, but the most satisfactory is the classification of Krafft-Ebing (q.v.), or some modification of it, such as the following table, as adopted in his lectures by M. Allen Starr (q.v.), of Xew York: Cla.ssific.vtiox of Mental Disease. .A, Mental diseases without apparent organic lesions. I. I'st/chonetiroses, in healthy brain. 1. Melancholia. a. simple. 6, with delusions. c, with agitation. d, with stupor. 2. !Mania. a, simple. b, with frenzy. 3. Confusional insanity. 4. Stuporous insanity. a, simple. Primary dementia. 6, with periods of ecstasy. Kata- tonia. 5. Terminal dementia. II. Psiichirnl de(}cncration in uealc brain. 1. Periodical psychoneuroses. 2. Partial degenerative insanity. a, emotional. Hj'sterical. 6, moral. c, impulsive. 3. Paranoia. B. Mental diseases with organic lesions. 1. Alcoholic insanity. 2. Senile dementia. 3. Syphilitic dementia. 4. Paretic dementia. C. ^lental defects with maldeveloped brain. 1. Imbecility. 2. Idiocy. .
additional group might be adiled. including
the citmplinilinft insanities, embracing traumatic, choreic, postfebrile, rheumatic, gouty, phthisical, sympathetic, and pellagrous insanity, as suggest- ed by Spitzka. Melancholia is characterized by a depressed
- Tuotiiinal state. (Sec ^Iei.anciioi.ia.) Mania is
characterized by an exalted emotional state. (S?e 3iANlA.) Confusional insanity is characterized by incoherence and confusion of ideas without essential emotional disturbance. It is a rare condition, dependent upon cerebral exhaustion, and follows emotional shock, cerebral overstrain, or exliausting disease. Some class it as a form of dementia. Stuporous insanity resembles con- fusional insanity. In it there is an impairment or suspension of the mental energies, without emotional disturbance; an indifference and in- dolence; an apatliy. It is an acute primary de- terioration following exhausting disease, excesses, shock, or hemorrbage. from which recovery is generally rapid. Katatonia is characterized by periods of ecstasy, during which the patient may be very voluble, alternatii.g with cataleptic or apathetic- intervals. (Spitzka.) Dementia is a weakened intcllectvial state in which thought, reason, and volition are impaired or suspended, considerable indiflerenee or total apathy existing. The patient is 'childish,' lives a vegetative existence, gradually losing intel- lectual ground, and drifting into mental decay. When this condition follows mania, melancholia, or other mental disease, it is called ter- minal dementia. Some terminal dements have periods of excitement, and are noi.sy and restless; but most are quiet, tractable, and childish. Periodical insanity is the term given to the mental state in neurotic patients who have recur- ring attacks of mental disease at fairly regular inten'als. Some will have an annual att:iek of mania for many years. Others will have a brief attack of melancholia with each snenstrual period. Some have an attack of melancholia of a few- days' duration, followed by an explosion of maniacal violence, lasting a week, and this in turn followed by a period of stupor or con- fusion. From the last the patient emerges in a few weeks, and a lucid interval of a few months follows. This is called circular insanity. Par- tial degenerative insanity occurs in people who have little .self-control, defective reasoning power, and impatience of restraint. It includes emo- tional insanity (folie raisonnantc) . in which baseless irritability, jealousy, outbursts of rage and fury occur; moral insanity, in which there seems to be an absolute want of appreciation of right and wrong, and the patient ignores all laws of custom, conventionality, decency, and morality; and impulsive insanity, in which the patients act on sudden impulses, without reason- ing, obeying imperative ideas, right or wrong, in spite of their wish to control themselves and do otherwise. (See Dipsomania: Kleptomania: Pyromania.) Paranoia is a chronic delusional insanity in -which intellection is imimpaired. (See Paranoia.) Alcoholic insanity is charac- terized by erotic ideas, hallucinations of sight, hearing, and smell, delusions of marital infiilelity, and great restlessness. In the chronic form the patient suffers from violent attacks of temper and fairly constant irritability. and the hallucina- tions constitute a daily torture. These hallucina- tions are always fearful; the patient fancying that he sees horrible animals, devils, enemies, or pitfalls, and that he hears threats, curses, ob- scene language, and noisy shouts, and that he smells foul odors, or dangerous electricity, or poisonous gases. (See Alcoholism.) In senile dementia the patient manifests a loss of af- fection for his relatives, delusions of grandeur or great egotism, suspicion withcnit cause, im- pairment of memory and of judgment, and delu-
