{
    "system": "GoGuides Verified Text",
    "api_version": "verified-text-v1",
    "status": "ok",
    "response_type": "verified_text_record",
    "source_key": "britannica_1926",
    "source_title": "Encyclopaedia Britannica (1926)",
    "license_code": "public_domain",
    "attribution": null,
    "license_url": null,
    "chunk_id": "1926:psychosis:ab708a71542f",
    "title": "PSYCHOSIS",
    "section": null,
    "hash_alg": "sha256",
    "hash_sha256": "3bcb71ee4293f39230f31d0fb22b469bdc73518e88a6dd9a667a8ef89e4545d2",
    "normalizer": {
        "name": "ggnorm",
        "version": "1.0"
    },
    "verified_text": "strictly speaking, the term psy- chosis means a state of mind, a concrete psychical process or a mental act; but is now generally used to signify an abnormal state of mind. this definition necds qualification, however, since the technical use of the term in psychiatry is confined to certain forms of mental disorder which can be distinguished from states of congenital mental deficiency on the one hand, and from “ borderland ” conditions or neuroses on the other. a dis- tinction should be made between “ psychosis ”’ and “ insanity,” which in popular and legal language signifies that an individual, owing to his state of mind, is unable to manage himself or his affairs, is in need of care and control and is not to be held accountable to society for his actions. psychosis, on the contrary, is a strictly medical term; it refers to a type of mental illness with certain intrinsic char- acteristics, assuming various forms, and due to a variety of causes. it does not necessarily lead to serious disturbances of behaviour, and there are many individuals who though not in- sane in a jegal sense are nevertheless the subjects of a pyschosis from the standpoint of psychiatry. psychological considerations though it is convenient to divide mental disorders into different categories based upon their causation, clinical characteristics or course and outcome, so many transformations of the clinical syndromes occur that no hard and fast division into separate disease entities is possible. one broad division is that made between the psychoses proper and the neuroses, a term embracing such morbid conditions as hysteria and obsessional neurosis. the difference between the two types of reaction is intuitively sensed by society jor reasons which become evident when their psychological characteristics are contrasted. one of the essential features of a neurosis ts the retention of what may be called the “ herd-sense,” and a psycho- sis is marked by its diminution or loss. in a neurosis the patient is oriented to realities and has an intelligence alive to his own needs; his symptoms tend to be provoked by external circum- stances, and he is sensitive to changes in the social atmosphere; he sees facts as they are but meets them in a faulty way. he does not seriously offend against the conventions, and however exacting his conduct may be his entourage still regard him as akin to themselves—as, indeed, he 1s, since all persons are apt to exhibit mild neurotic symptoms when life becomes too com- plex and ditlicult. in a psychosis, however, the irruption of images, feclings and cravings into consciousness leads to distorted views of reality and to falsification of facts; the sentiments and habits of the patient undergo a change, and his conduct becomes inexplicable and (apparently) unmotivated; he becomes inditferent to public opinion and impervious to solicitations from without; brietly, he loses touch with common life and lives in a world of his own. such attitudes naturally provoke uneasy tensions in normal people; they feel themselves to be in the presence of something uncanny and outside the range of their experience. it is dis- concerting to deal with an individual whose conduct fails to be influenced by the methods hitherto found effective in dealing with other human beings, and no doubt the fear of the bio- logically abnormal has something to do with the attitude of society towards the psychotic. brit, jour. 257 psychosis and neurosis—a psychosis is thus a malady of more serious import than a ncurosis. the latter is a regressive and infantile mode of adjustment to reality—an act of adapta- tion that has failed (jung). in a neurosis, fears, obsessions, doubts, ruminations, day-dreams and crises of agitation—in- complete, exaggerated and unproductive mental operations in- volving but little effori—serve as substitutes for eflicient action. some years ago freud described the neuroses as defence mechan- isms, and the validity of this conception was demonstrated in the war neuroses, where the conflict between duty and the instinct of self-preservation was solved without the sacrifice of social esteem by the automatic devclopment of tremors, paralyses and anxiety states, which, as rivers showed, were modifications of those instinctive processes by which all the higher forms of animal life were accustomed to react to danger. protective function of neuroses-——here the neurosis clearly served to protect its subject from the situations for which he lacked the proper personal adaptation; it acted as a structure of compromise between himself and society; and it symbolised the nature of the instinct which demanded an outlet and grati- fication. ‘the neuroses of peace have a similar mechanism and fulfil a similar function, though the nature of the instinctive need which finds an outlet in neurotic symptoms is the subject of considerable controversy. freud traces it to the sexual impulse, while janet discovers in the behaviour of a neurotic a means of gaining power and love which he lacks the capacity to earn by vigorous and effective action. psychosis and destruction——in contrast to a neurosis which acts to the advantage of the individual by protecting him from an uncongenial environment, a psychosis always acts in the long run to the disadvantage of the individual, and tends to bring him into conflict with society. it is destructive rather than pro- tective, and tends to eliminate rather than to conserve the individual as a social unit. a psychosis originates in the depths of the organic life. the images which flood the psychic hfe are stimulated by subtle changes in the vital processes responsible for the evolution of the personality, and remain until the organic balance is restored. hesnard names this process organic sym-~ bolism, pointing out that just as the sensation is the symbolic translation or meaning of the exciting stimulus and not this stimulus simply transmitted, so the psychosis is the psychic interpretation of organic occurrences. this formula may be applied to the psycho-physiology of hunger, which torro aptly describes as an “ echo of physiological distress and at the same time the dawn of psychic life.” a morbid instance of this proc- ess occurs in the climacteric psychoses, in which the patient often complains of being dead, of ceasing to exist, or of being a shadow without life (delusion of negation). here the biological changes heralding the termination of reproductivity are clearly symbolised in the content of the psychosis. the delusions and hallucinations of the psychotic should thus not be regarded as fancies; they are the symbols of organic actualities. the patient is right in adhering to his beliefs; he knows and feels them to be true, and has more reason on his side than the psychiatrist who would vainly persuade him to the contrary. zwo groups of psvchosis.—the difierentiation by kraepelin of the psychoses into two broad groups—manic-depressive in- sanity and dementia praecox—has been of inestimable service to psychiatry, though his view that these should be regarded as distinct disease entities has not been established. it is more in accordance with clinical facts to regard them as two reaction types which sometimes occur in pure form but more often as mixed. the manic-depressive reaction is characterised by se- vere and irregular fluctuations of mood in the directions of excitement and depression with intervals of normality. the psychosis is an exaggeration of the “ cyclothymic ” reaction of some normal people in whom the mood fluctuates between euphoria and depression more or less independently of cir- cumstances. dementia praecox tends to pursue an unfavourable course, and js characterised by a peculiar and often complete disorganisation of personality with predominant changes in the affective life and will. 258 schizophrenia and paraphrenia.—as the disease does not always proceed to dementia, and may develop at any age, bleuler prefers to apply to it the term schizophrenia (splitting of mind). jung has stated that the essence of dementia praecox consists in the fact that the unconscious to a large extent re- places the conscious, and the validity of this formulation is clearly exemplified in those schizophrenics to whom the term paraphrenia is given. this psychosis is marked by the exuberant development of fantastic delusions and hallucinations, which appear all the more extraordinary as ihe personality is so pre- served as to enable the patient to make a normal reaction to social life on occasions. the morbid mental products in these cases can properly be regarded as an echo of the ultimate realities of organic life. as blondel observes: ‘ la conscience morbide s’exprime en dehors des lots de la conscience sociale par des pre- cedes, non plus seulement prerationnels, mais prenormaux, qui mianifestent pindividuel pur.” in the schizophrenic there is an hypertrophy and distortion of the instinctive life, and the delusions and hallucinations symbolise or reveal crudely the elemental cravings which seek expression. the psychosis has thus an important biological function, affording a means by which the inward craving can be actualised and freely expressed; it brings about a state of biological equilibrium by permitting a release of organic tension. these paraphrenic cases are of the highest psychological interest. it is possible at times to watch the growth of organised hallucinatory svstems which assume the characteristics of omnipotent and god-like personalities, symbolising, as it were, the ruthless and impersonal forces of nature. the interactions between the personality of the patient and the forces which control it are often as dramatic as those between the mythological characters of greek tragedy; and the psychosis, like the latter, fathoms the depths of human life. causation and treatment of psychoses.—a psychosis is a dis- order of behaviour, and represents a failure of function at the psychological level. psychiatry (q¢.2.) thus differs in its subject- matter from general medicine; the former deals with disturbances in the reactions of the organism as an integrated whole, and the latter with disorders of special systems of organs. since the be- haviour of an individual, whether normal or abnormal, depends upon an infinity of factors—the nature of his life situations, the state of his organism, and the whole of his past .history, both personal and ancestral—it is impossible to select one factor as explanatory of the total reaction. the problem of causation in the psychoses is thus dissolved in relativity, and in each case an endeavour is made to seek out, and remove where possible, any factors, either physical or mental, which seem to be exerting an unfavourable influence upon the behaviour. mode of approach.—there is now a general tendency to ap- proach the problems of mental disorder from the standpoints of biology, pathology and general medicine, as it is recognised that the psychoses must be the outcome of a malfunctioning organism. many psychoses, indeed, have definite relationships to diseases of the nervous system and of the bodily organs, as well as to general disturbances due to infections, exhaustion and drug intoxications. the causal significance of foci of chronic infections from the nose, throat, teeth, uterus or intestines has recently been emphasised and investigations along these lines make it evident that the whole resources of medicine should be utilised in the treatment of mental disorder. mind cannot be regarded as an entity and detached from the body, and the se- crets of disordered personality cannot be discovered by con- fining researches to the brain. the mind is not merely a function of the brain; it is a function of the whole organism having its roots in the viscera, the endocrine glands, the vegetative ner- vous system and the musculature. clinically, the biogenetic psychoses, the general characters of which have been outlined above, appear primarily due to deterioration and distortions of the affective and instinctive rather than of the intellectual func- tions, and such impressions are confirmed by the researches of mott in relation to dementia praecox, showing that the disorder is the expression of an inborn lack of durability throughout the body, but most manifest in the organs of reproduction. psychotherapy biogenctic psvchoses—in contrast to the toxic-exhaustive group of psychoses or an organic psychosis such as general paralysis, which are accidental episodes in the life of normal people, the biogenetic psychoses are the outcome of an heredi- ary or constitutional predisposition to mental disease. the psychotic episodes may be excited by mental or physical stresses, but the tendency already exists. the different forms assumed by these psychoses are independent of any specific pathogenic agent and dependent upon the personality, make-up or inborn psychic constitution. thus a manic-depressive psychosis is con- sidered to exhibit an exaggeration of a pre-existing cyclothymic or extraverted temperament, and dementia praecox of a pre-exist- ing schizophrenic or introverted temperament. kretschmer has noted a relationship between certain forms of physique and these psychic types. he finds that the cycloid types show a bio- logical affinity with a pyknic body-build, while the schizoid types are related to asthenic and athletic body-builds, together with certain dysplastics. this work sheds light on the organic foundations of temperament, and has an intimate bearing on the problem of the biogenetic psychoses. treatment problems —the psychoses do not offer a fertile field for the application of formal psychotherapcutic procedures, such as hypnotism and psychoanalysis; their subjects lack insight and sense of illness, and tend to be non-co-operative and impene- trable. indirectly, however, psychological treatment plays a large part in the prevention, cure and amelioration of psy- choses. thus re-education, the elimination of faulty habits of reaction and the stimulation and exteriorisation of interest by work and recreation are essential elements in treatment. every administrative act intended to increase the amenities of patients in a mental hospital is mental treatment, and results in an im- provement in the reactions of the patients as a whole. the more the freedom allowed, the more the institution corresponds to the conditions of ordinary life, and the more the contacts with the outside world the more normal the patients become. individ- ual peculiarities and unsuspected sensitivities (conditioned re- sponses) must be noted. thus a relapse may be provoked by the visit of a wife; an inaccessible schizophrenic may break into blushes, smiles and loquaciousness when visited by her father; ora patient may exhibit a negativistic attitude to one nurse and respond with friendliness to another. influence of psychogenctic factors —dpsychogenctic factors thus largely influence for better or worse the reactions of a psy- chotic. jung points out that a normal introvert in a thoroughly congenial environment expands and relaxes towards complete extroversion; conversely, a sensitive shut-in child may regress into a mild psychotic state in what (to him) constitutes an un- friendly environment where he is not understood. such obser- vations have an important bearing on the problem of heredity. some psychiatrists suggest that the continual association of a child from birth with exacting psychopathic parents (psychic trauma) is responsible for the development of psychoses later in life, but no doubt the inborn predisposition is an essential element in the causation of such cases. psychogenetic factors are certainly in part responsible, however, for breakdowns of the dementia praecox type, and many such might perhaps be avoided if the significance and dangers of an inborn sensitivity were more generally appreciated. brpiiocrapiny.—c. g. jung, collected papers on analytical psychology (1917); w. a. white, foundations of psychiatry (1921); w. h. r. rivers, zastinct and the unconscious (1922); h. devine, * the reality feeling in phantasies of the insane,\" brit. jour. psych. (1923); a. vesnard, l’inconscient (1923); e. kretschmer, physique and character (1925); p. janet, psychological healing, 2 vol. (1925). (h. d.) psychotherapy.—-the method in psychotherapy that especially characterises the period since rgio, is the method of psychoanalysis devised by sigmund freud, and the theory based upon its findings bulks largely in all modern discussions. modern developments.—leaving aside this modern method of psychoanalysis, (see psychoanalysis, freudian sciiool of) we find that with many other workers in psychopathology aad psy- psychotherapy chotherapy there has been a steady movement away from the em- ployment of hypnotism, whether for the investigation of the mind or for its treatment. pierre janet and morton prince alone among the older workers have continued to employ hypnotism in selected cases. dubois, of berne, has modified the suggestion treatment of liebault and bernheim in the direction of an appeal to reason in the patient rather than to mere automatism. in this method we find the arts of persuasion developed to the ut- most on the conscious plane. the patient is encouraged to look at himself sincerely, to see himself exactly and to find out what is wrong with himself, what is the cause of his symptoms, and then is persuaded to change his mental outlook. the symptoms may be helped sometimes by philosophical disquisitions and ex- hortations. dejerine advocated a similar method of analysis and persuasion, in which through a series of talks with the patient, the doctor induces him to admit what is really wrong with him, and encourages him to get out of his difficulties and so dispense with his symptoms. babinski holds a simple theory of the nature of hysteria, according to which it is caused by suggestion and therefore curable by persuasion. the methods of persuasion which he indicates are of the simplest. analytic psychology.—c. g. jung and a. adler have broken away from the direct freudian line of thought. jung calls his method that of analytic psychology, and emphasises the special need of analysing the present situation of the patient, inter- preting his past in the light of his present, quite as much as con- versely. he does not accept the freudian view of the sexual etiology of the psychoneuroses, and although he uses the word libido in his general theory, this means for him gencral emotional energy, not specifically sexual energy. his general theory is one of indeterminism in contrast with the ngid determinism of freud. self- assertion adler emphasises the important part played in the formation of nervous symptoms by the fundamental instinct of self-assertion—the will to power. in his view many neurotic symptoms are compensatory, representing the patient’s (unsuccessful) striving ‘‘ to become a complete man ”’—that is the phrase he uses—and to hide his insufficiency from himself as well as from others. the patient constructs a safety net, as it were, around himself, so as to prevent his sensitive ego from being unduly pained by the consciousness of its inadequacy. adler would explain many cases in which a sexual etiology seems more obviously involved as really caused in this other way, through disturbance of the self-assertive instinct. the patient’s self- assertive instinct cannot realise itself in ordinary ways, so it realises itself in a round-about way. all the time there 1s a tendency for the person to conceal from himself his own in- adequacy, or to prevent himself from facing a situation where his own inadequacy might become too obvious. he may become ill in order to escape having to face a task to which he knows that he is inadequate. the feeling of inadequacy is translated into a feeling of illness. this inadequacy may show itself in va- rious ways. adler claims that the psychological essentials of a case may often be revealed in a single interview. war cases.—dutring the world war various forms of psycho- neurosis were produced by the conditions of warfare in thousands of cases, and some of pierre janet’s most fundamental views on the nature of hysteria were verified. among the numerous cases of shell shock a certain proportion suffered from hysterical symptoms, and it was found that these hysterical cases were easily hypnotised, and through hypnosis the man could be re-associated, and his hysterical tendencies thereby diminished. in other words the scientific validity of janet’s use of hypnosis in special cases, was confirmed by the investigation and treatment of hundreds of such cases in the battle area. in ordinary medical practice these cases are not numerous. the ordinary medical man sees only a few cases a year, but when they are seen by the hundred as during the war, general conclusions can be drawn about them, they can be distinguished definitely from other cases, and cases _ of so-called natural somnambulism were most quickly cured by the production of artificial somnambulism under special safe- guards. in other cases suggestion treatment is beneficial. 259 hypnotic treatment.—there is thus still a place for hypnotic treatment in psychotherapy. it should be limited to the treat- ment of pronounced cases of hysteria with loss of memory and crude automatisms like somnambulism, hysterical attacks and fugues. in such cases it removes the symptoms, and «diminishes the hysterical tendency also. to correct the hysterical tendency still more adequately, it would seem desirable to give the patient a certain amount of analytic treatment, discussing his past life with him, sorting out his past experiences, and helping him to sce the relation of these past experiences to his present mental state (u2lognosis). suggestion.—the method of suggestion in the waking or sub- waking state, without hypnosis, has been re-introduced into practical psychotherapy by emile coue, baudouin and others. the special characteristic of the method is that it emphasises the auto-suggestion element in all suggestion—emphasises the gen- eral fact that autd-suggestion is fundamental in all suggestion treatment, and that auto-suggestion may be encouraged, so that it takes the place of hetero-suggestion. patients should be en- couraged to treat themselves by auto-suggestion; and to do so they should put themselves into a passive state of concentration without effort (confention), in which state anv suggestion they give to their own sub-consciousness has more opportunity of becoming realised. tsolation.—besides these more specific mental methods of treatment there are certain physical methods, which may be classed as psychotherapeutical methods, since they are devised for their mental effect upon the patient. one such method is that of isolation, applied, e.g., by dejerine, in whose clinic isola- tion was often made as complete as possible. a curtain was drawn round the patient’s bed, and he was allowed to see no one but the doctor. another subsidiary method of treatment is that during the first fortnight of this isolation treatment, the patient is put upon a milk diet (see weir-mitchell treatment, 26.803). work cure.—the rest cure has its antithesis in a work cure advocated by some doctors, but the work cure is obviously only applicable in special cases, and where the work is congenial and does not make too large demands upon the patient’s energy it should be very effective. pottery-painting, mat-weaving, chair- making, carpentry, metal work, etc., have been found very help- ful to certain types of patients. simple mental exercises are also helpful. exercises.—massage and relaxation exercises are sometimes important, and still more important are active exercises such as golf, riding, tennis and other games of skill, which can be a great help in getting patients back to the normal. in cases where thereis a lowered psychological tension which has to be corrected the patient needs distraction and stimulation. stimulation 1s also needed where a patient is so lethargic that his fatigue is due not to outgoing energy but to failure to create energy. there are some lethargic patients who will not make any effort, and suffer from not developing sufficient energy, and in these cases stimula- tion is needed in one form or another. cases on the verge of severe depression, where the tendency is to sit still and do nothing, are sometimes greatly helped if they take up riding, a stimulant that can raise the psychological tension sufficiently to take them out of themselves. motoring and motor cycling are also useful. they involve great concentration of attention, and certain types of patient obtain much help from this continuous concentration of mind, who have become so scatter-brained and distracted that they have lost the power of steady concentration. if the mind is concentrated in one direction it receives a fillp towards concentration and unification in other directions also. treaiment difficulties —it is quite obvious that these diverse methods, many of which seem to be contrary in their results, should be recommended with discretion. different methods are applicable to different cases, and to the same cases in different stages of illness. the practical thing in psychotherapy is, to a great extent, skill in the choice of means. where skill can be shown is in the careful choice of means for different patients and for the same patient at different times. this is not a matter of routine, it cannot be described satisfactorily in a set of written 260 instructions, but it is gradually acquired by the physician in the course of practice, breliocrariy.—p. dubois, the psychic treatment of nervous disorders (1909); b. hart, psychology of insanity (igt2); j. j. dejerine and 12, gauckler, psychoneuroses and psychotherapy (1915); j. babinski and j. fromont, j/ysterta or pithiatism (1gt7); c. g. jung, collected papers on analytical psychology (1917); h. crichton miller and others, functional nerve disease (1920); a. adler, the neurotic constitution (1921); w. brown, psychology and psycho- therapy (1921); m. prince, the unconscious (1921); t. w. mitchell, medical psychology (1922); w. h. r. rivers, zustinct and the uu- conscious (1922); w. mcdougall, an outline of psychology (1923); t. a. ross, the common neuroses (1923); p. janet, psychological tlealing, 2 vol. (1925). cw. br.)",
    "source_url": "https://archive.org/details/encyclopaedia-britannica-encyclopaedia-britannica.-3-encyclopaedia-britannica-inc.-1926",
    "observed_at": "2026-05-17 12:14:22",
    "integrity": {
        "hash_check": "match",
        "hash_scope": "full_normalized_text",
        "computed_sha256": "3bcb71ee4293f39230f31d0fb22b469bdc73518e88a6dd9a667a8ef89e4545d2"
    },
    "machine_use": {
        "read": true,
        "cite": true,
        "decision": "verified_public_domain_text"
    },
    "documentation": {
        "white_paper_url": "https://www.goguides.com/white-paper.php",
        "pdf_url": "https://www.goguides.com/whitepapers/goguides-ai-source-clearance-white-paper.pdf"
    }
}