Page:Popular Science Monthly Volume 85.djvu/583

Rh up as the shut-in personality. In the time at my disposal the conception can not be fully discussed. The characteristic picture, however, is one of repression, seclusiveness, secretiveness, failure of normal "participation in cares, pleasures and pursuits" of others, self-centered stubbornness as contrasted with aggressive persistence, special oddities of conduct, the so-called "in-growing conscience," strong religious or mystical trends, with relative emphasis of passive virtues. A concrete example is described in the following words:

As a child he was precocious but in school had to study hard. He lacked confidence, was pessimistic, brooding and egotistical in disposition. He preferred reading to athletic sports, and gave religious scruples as a reason for not attending the theater. He did not use alcohol, tobacco, tea or coffee, and it was also noted that he did not care to associate with the opposite sex. At the age of 17 he began work as a clerk and was steady, honest and exact. ...

The manic-depressive group shows a larger number of cases where abnormal traits are not seen before the psychosis, and the shut-in traits are nearly absent. But as an elementary point here it is brought out in some recent figures of Hoch's that persons who develop manic-depressive psychoses have also shown special tendency to exaggerated emotional reactions in their normal lives. These may be of either a euphoric or a depressive nature; when they are euphoric the individuals are more likely to have manic attacks, when they are depressive to have depressive attacks; and the melancholic personalities, manic ones. The apparent influence of the personality on the form of the attack diminishes to zero as the difference between the cheerfulness and depression of spirits in health becomes less marked.

In dementia præcox the psychotic mode of adjustment is regularly adhered to; in other words, the psychosis is not recoverable. The manic-depressive states, whose picture is as a whole much less detached from reality, represent rather a temporary mode of adjustment; that is, the psychosis is recoverable. The manic-depressive psychosis makes for any port in a storm; dementia præcox scuttles the ship.

Both conditions, however, with paranoia, and in a more circumscribed way the neuroses, show definite and systematic effort of adaptation to the patient's life-circumstances. The final understanding of these cases is given in the questions, "Why did you have to have this thing?" what made this adjustment a necessary one for the patient? and what needs must now be met in a more normal way, what particular danger points must be guarded, what false views of life corrected?

It is now apparent, I hope, that the mental criterion of psychosis is essentially one of mental maladjustment to the surroundings, and often it is the only criterion, mental or physical. The individual differences that distinguish psychotic and normal personalities are not so much differences in motor power, sensory acuity, affectivity or intellect, but