NZMJ, 1922.

By Stuart Moore, B.A., M.D., M.R.C.P., Lecturer on Clinical Medicine, Otago Medical School.

The use of the term “functional” to describe the milder mental disorders such as hysteria, the obsessive or compulsive neuroses, anxiety states, and neurasthenia, should be discarded for two reasons.

Firstly, organic disease, e.g., cancer of the stomach, causes, like any other organic disease, a disturbance of the functions of the organ concerned, and secondly, what has been called “functional” disease, is now regarded as of psychic or mental origin. The distinction that is practically of importance is that between disease which is due to organic change and disease which is of purely mental origin. The objection to calling hysteria mental disease is the odium attached to the phrase, but the use of the term “psychic” avoids this.

The treatment of these milder forms of mental disease is one of the utmost practical importance, and in this connection in this journal two questions have recently been raised. One is the value of psycho-analysis, and the other is the need for and the method of use of institutional treatment.

If all the hysteria, etc., is to be treated in a special institution it will need to be a very large one. These milder mental disorders are among the most crippling ills that man is heir to. The wage-earning capacity, or efficiency of life, is seriously impaired by them, often for prolonged periods. Expense of treatment is therefore an important consideration. At the present time the treatment they receive is often prolonged and expensive. They are isolated in private hospitals and massaged, etc., or undergo prolonged courses of medicine with a variety of tonics or of sedatives. They are sent away on holidays or to special institutions. The treatments sometimes do good, but often they do no good, and the chiropractic steps in. The success of the chiropractic is due chiefly, I take it, not to any great amount of good in that system, but to the fact that the medical profession, speaking broadly, does not understand these mild mental ailments. An attitude very commonly adopted towards these patients recalls the ancient manner in which lunatics were regarded and cruelly treated.

Associated with the question of institutional treatment of the hysteric is the question of the utility of psycho-analysis. For some 10 or 12 years I have studied this form of treatment. My practice of it I have allowed gradually to grow, as my self-analysis progressed and definite opinions on it formed, and as I felt able to undertake more of the work. Now I find I am able, without undue fatigue, to practise the treatment for five or six hours daily. I find that in the practice of a general physician there are many cases where a few treatments, one to three, produce a most beneficial result, and that in definite pronounced cases the treatment often gives success otherwise unobtainable. It is particularly effective in young people, but I have gained good results in cases over 50. In most cases my patients have lived at home and frequently have followed their ordinary avocation while under treatment.

I propose to give, as bearing on the question of institutional treatment, and on the questin of psycho-analysis, a brief account of some work done during the last six months. The report shows a fair average of results

EPILEPSY—(1) Girl aged 21. This case had been subject to fits from 8 years of age. I saw some of the fits, and they were definitely epileptic. There were also numerous hysteroid or psychotic symptoms associated, e.g., a desire to cut her throat. This girl’s life was gradually being narrowed down, for she could not be allowed to go to church or out for the evening as she would take fits. She could not even be allowed to go out for short messages. She was becoming dull and doing nothing. Treatment consisted of under twenty sittings one hour each once a week. It was stopped three months ago. There have been no more fits. The girl is happy and cheerful, working at home, and practising the piano. The last I heard of her is that she was going to dances. The friends are very pleased and have thanked me profusely.

(2) A boy, aged 15½ year, had taken five fits in two months. Diagnosis hystero-epilepsy. A borderland case with elements of epilepsy, migraine, and hysteria. He had been advised to leave his work and go into the country. My treatments consisted of four sittings. There have been no more fits in five months, and he worked during treatment, and has been at work ever since.

(3) A thin, miserable, nervous woman with anxiety, tremblings, attacks in the legs like Raynaud’s disease, and many other symptoms. Treatments, eight in number, one of three hours’ duration, in which I sat and listened to one of the most graphically presented tragedies I have ever heard. Result, very great improvement. One attack of shaking in the last three months. Appetite is good, general condition is much improved. She should have one or two more treatments.

(4) Woman, aged 49 years, who had, some years previously, threatened suicide, and was going the same way again. Treatment, fifteen sittings, depressions and suicidal tendencies disappeared. Patient very much better, and everybody pleased. (This patient was a sister of one whom I cured of an anxiety neurosis in six sittings the previous year. As a result of that cure her constant attendance at doctors for the prescription of tonics has ceased.) In addition to analysis I restrained the tyranny of the old mother over the patient.

(5) A young man with wet dreams—three treatments—result satisfactory. Perhaps this case has been benefitted really by suggestion.

(6) A woman, 35 years, constantly sending to the doctor for tonics, and buying patent medications. After taking two doses of a bottle it was put down the sink. Treatment, some preliminary visits, then three treatments—cure of these bad habits, and improvement in other ways, but cure of nervousness is complete.

(7) A man, aged 20, with giddy turns and a bad temper. Three treatments, cured to the satisfaction of his wife.

(8) A man with giddy turns incapacitating him from work—returned for treatment which has been applied during previous year—able to work pretty fully, but still has some giddy turns, though they are not nearly as bad as they were. In this case there was no result worth speaking of for twelve treatments (three months) and then sudden marked improvement.

(9) Woman, aged 45, at climateric. Feels inclined to hide behind a door when she meets people, trembling attacks, etc., still under treatment. Treatment, twelve sittings, feeling of shame gone, better in every way, attacks of trembling still occur, but are less frequent, and less severe.

(10) Man aged 55, to return for further treatment after having been relieved of a desire to go to into a lunatic asylum as a voluntary patient. This patient is old in his arteries, and I warned him I might get no result. Patient is glad he has undergone treatment, but result is not satisfactory, although a good deal better than I promised him. He is still under treatment.

NZMJ, 1922.

By Stuart Moore, B.A., M.D., M.R.C.P., Lecturer on Clinical Medicine, Otago Medical School.

The use of the term “functional” to describe the milder mental disorders such as hysteria, the obsessive or compulsive neuroses, anxiety states, and neurasthenia, should be discarded for two reasons.

Firstly, organic disease, e.g., cancer of the stomach, causes, like any other organic disease, a disturbance of the functions of the organ concerned, and secondly, what has been called “functional” disease, is now regarded as of psychic or mental origin. The distinction that is practically of importance is that between disease which is due to organic change and disease which is of purely mental origin. The objection to calling hysteria mental disease is the odium attached to the phrase, but the use of the term “psychic” avoids this.

The treatment of these milder forms of mental disease is one of the utmost practical importance, and in this connection in this journal two questions have recently been raised. One is the value of psycho-analysis, and the other is the need for and the method of use of institutional treatment.

If all the hysteria, etc., is to be treated in a special institution it will need to be a very large one. These milder mental disorders are among the most crippling ills that man is heir to. The wage-earning capacity, or efficiency of life, is seriously impaired by them, often for prolonged periods. Expense of treatment is therefore an important consideration. At the present time the treatment they receive is often prolonged and expensive. They are isolated in private hospitals and massaged, etc., or undergo prolonged courses of medicine with a variety of tonics or of sedatives. They are sent away on holidays or to special institutions. The treatments sometimes do good, but often they do no good, and the chiropractic steps in. The success of the chiropractic is due chiefly, I take it, not to any great amount of good in that system, but to the fact that the medical profession, speaking broadly, does not understand these mild mental ailments. An attitude very commonly adopted towards these patients recalls the ancient manner in which lunatics were regarded and cruelly treated.

Associated with the question of institutional treatment of the hysteric is the question of the utility of psycho-analysis. For some 10 or 12 years I have studied this form of treatment. My practice of it I have allowed gradually to grow, as my self-analysis progressed and definite opinions on it formed, and as I felt able to undertake more of the work. Now I find I am able, without undue fatigue, to practise the treatment for five or six hours daily. I find that in the practice of a general physician there are many cases where a few treatments, one to three, produce a most beneficial result, and that in definite pronounced cases the treatment often gives success otherwise unobtainable. It is particularly effective in young people, but I have gained good results in cases over 50. In most cases my patients have lived at home and frequently have followed their ordinary avocation while under treatment.

I propose to give, as bearing on the question of institutional treatment, and on the questin of psycho-analysis, a brief account of some work done during the last six months. The report shows a fair average of results

EPILEPSY—(1) Girl aged 21. This case had been subject to fits from 8 years of age. I saw some of the fits, and they were definitely epileptic. There were also numerous hysteroid or psychotic symptoms associated, e.g., a desire to cut her throat. This girl’s life was gradually being narrowed down, for she could not be allowed to go to church or out for the evening as she would take fits. She could not even be allowed to go out for short messages. She was becoming dull and doing nothing. Treatment consisted of under twenty sittings one hour each once a week. It was stopped three months ago. There have been no more fits. The girl is happy and cheerful, working at home, and practising the piano. The last I heard of her is that she was going to dances. The friends are very pleased and have thanked me profusely.

(2) A boy, aged 15½ year, had taken five fits in two months. Diagnosis hystero-epilepsy. A borderland case with elements of epilepsy, migraine, and hysteria. He had been advised to leave his work and go into the country. My treatments consisted of four sittings. There have been no more fits in five months, and he worked during treatment, and has been at work ever since.

(3) A thin, miserable, nervous woman with anxiety, tremblings, attacks in the legs like Raynaud’s disease, and many other symptoms. Treatments, eight in number, one of three hours’ duration, in which I sat and listened to one of the most graphically presented tragedies I have ever heard. Result, very great improvement. One attack of shaking in the last three months. Appetite is good, general condition is much improved. She should have one or two more treatments.

(4) Woman, aged 49 years, who had, some years previously, threatened suicide, and was going the same way again. Treatment, fifteen sittings, depressions and suicidal tendencies disappeared. Patient very much better, and everybody pleased. (This patient was a sister of one whom I cured of an anxiety neurosis in six sittings the previous year. As a result of that cure her constant attendance at doctors for the prescription of tonics has ceased.) In addition to analysis I restrained the tyranny of the old mother over the patient.

(5) A young man with wet dreams—three treatments—result satisfactory. Perhaps this case has been benefitted really by suggestion.

(6) A woman, 35 years, constantly sending to the doctor for tonics, and buying patent medications. After taking two doses of a bottle it was put down the sink. Treatment, some preliminary visits, then three treatments—cure of these bad habits, and improvement in other ways, but cure of nervousness is complete.

(7) A man, aged 20, with giddy turns and a bad temper. Three treatments, cured to the satisfaction of his wife.

(8) A man with giddy turns incapacitating him from work—returned for treatment which has been applied during previous year—able to work pretty fully, but still has some giddy turns, though they are not nearly as bad as they were. In this case there was no result worth speaking of for twelve treatments (three months) and then sudden marked improvement.

(9) Woman, aged 45, at climateric. Feels inclined to hide behind a door when she meets people, trembling attacks, etc., still under treatment. Treatment, twelve sittings, feeling of shame gone, better in every way, attacks of trembling still occur, but are less frequent, and less severe.

(10) Man aged 55, to return for further treatment after having been relieved of a desire to go to into a lunatic asylum as a voluntary patient. This patient is old in his arteries, and I warned him I might get no result. Patient is glad he has undergone treatment, but result is not satisfactory, although a good deal better than I promised him. He is still under treatment.