CHAPTER XXI.

BORDERLAND AND EPISODIC STATES.

OBSESSIONS, PHOBIAS, IMPULSES.

THE Conditions of mental aberration here considered comprise quite a wide range of symptoms of equally varying gravity, some of them comparatively trivial and not specially of serious import, while others are indicative of marked degrees of degeneracy and are formidable in themselves. They agree only in the fact that they do not fall readily into any of the special forms of insanity described, that in them the intelligence is not materially implicated, and that in all there is a decided nervous weakness involving more or less that mental function that we call the will. Except in their most pronounced development, or when associated with other clearly insane manifestations, they seldom are met with in the asylums, but they are common in the experiences of outside practitioners, and in some of their mildest forms can almost be said to be matters of common experience. There are probably few normal individuals who have not felt at least a suggestion of a morbid impulse under certain favoring conditions, or had a haunting idea that was not far from an obsession at some time in their lives. They comprise a true borderland between mental sanity and disease, and are found well over both sides of the indefinite dividingline that separates these states.

The peculiarities and oddities of some persons that go under the general names of eccentricities, crankiness, etc., have been already incidentally noticed in connection with certain forms of insanity, etc. These are

generally indications of degeneracy, and in some cases the individuals are really only mild instances of some form of mental derangement-circular or periodic insanity or original paranoia; in others the apparent eccentricities are only racial peculiarities or the results of early training emphasized by a special environment, as suggested by Kiernan in the case of Thomas Carlyle. There is, however, a certain number of eccentrics whose aberrations cannot be accounted for in either of these ways, and who make up the class of disequilibrates, or, in common language, "cranks." While they may never become actually insane in the legal or medical sense of the term, they are frequently the descendants or progenitors of lunatics, and the family history shows their real position on the borderland of mental alienation. These individuals are often mentally brilliant in some directions; many of the unbalanced or irregular geniuses are of this type. Others are mediocre in talent, and only exhibit a lack of mental balance that handicaps them in the competition. and struggle of existence. A very common peculiarity is in their writing-the undue use of italics, for example, so characteristic of a certain class of these disequilibrates. It is almost impossible, however, to definitely define them, as their symptoms and peculiarities are manifold, and they shade off imperceptibly into the average individuals. It is only when their abnormalities are rather striking that they can be reckoned as belonging properly on the borderland of insanity. It is rare for these persons to be in any sense dangerous or to require sequestration, except when, as sometimes happens, the degenerative predisposition causes them to succumb more readily than others to attacks of actual mental derangement.

The class of eccentrics or cranks stand on the borderland of insanity by reason of their mental twist or deficiency; they are for the most part nearer the original

paranoiacs and the imbeciles than to other types of mental disease. They hardly come within the scope of the present chapter, which mainly treats of a quite different class of borderland conditions that are for the most part comprehended under the head of obsessions a French term which has become naturalized in our language as the most expressive and descriptive for these states. The term The term "obsession" is here used in its wider sense as covering all the will defects characteristic of these conditions, not in the narrower sense of simple imperative ideas, and not including all the impulsions and aboulias as well. All these symptoms, whether affecting directly the emotions or the intellect, are essentially defects of the will; they have in common the character of being recognized as morbid by the subject himself, and they have been classed by recent writers as belonging to the neurasthenias, as being symptoms of functional weakness of the higher cortical centers. They are commonly said to be usually hereditary, but in our observation this is not by any means always the case. Practically they are only exaggerations of the experiences of most, if not all, normal individuals, and it is only through the degree of this exaggeration that they carry their victims over on the borderland of mental health. We are all of us subject to morbid impulses and to besetting mental conceptions or obsessions, but with most of us these are only transient, and are fully controlled by the intelligent will. It is only in certain conditions of nervous exhaustion or in persons who are naturally defective that these defects become actual obsessions. We must remember, also, that a certain degree of defectiveness is the rule; no one is perfect physically or mentally, and the individual who is perfectly free from all stigmata of degeneracy probably does not exist. It is this inherent element of degeneracy in us all that comes into play, so to speak, in these neuras

thenic manifestations that lie on the borderland of mental disease.

Following the classification of Regis, whose chapter on these symptoms is one of the best general summaries of the subject, we can divide the obsessions first into. impulsive types, where the suggestion or feeling that lies at the basis of these symptoms is not controlled by the inhibitory action of the will. Under ordinary healthy conditions we have the power of choice in our ideas and resulting actions; no one of them becomes predominant so that we cannot substitute for it another. In this obsession the victim of the impulsion is impelled to act and think against his judgment, and in extreme cases, where the volition is altogether disabled, may do the most absurd or even criminal acts, or be tormented with the most unreasonable fears or doubt, being all the time fully conscious of their absurdity and impropriety. Regis divides these impulsions or impulsive obsessions into (1) the obsessions of indecision; (2) the obsessions of fear (phobias); and (3) the irresistible propensities or morbid impulses.

Obsessions of Indecision. The most typical form of this class is the folie du doute, or doubting insanity, as it has been called. In its mildest form it is by no means uncommon; it may exist merely as a tendency to question one's acts-to be troubled with an uncertainty as to whether one has locked a door as he should, for example. Another form is what the Germans have called Grübelsucht, or metaphysical mania, where the individual distresses himself over abstract or ridiculous questions. Still others are in constant distress for fear that they have mistaken the address on a letter that they have sent, or some equally trivial matter. In one case observed the patient would spend hours in going back and forth before starting anywhere, each start being balked by the fear that something or other had not been done that ought to have

been done. Even the going up and down stairs to and from his room was interrupted the same way; he would go back and forth indefinitely until stopped by almost the use of force. Still others are troubled with religious scruples; they have an abiding fear that they have committed some sin, possibly a trivial one, but it may occupy their mind almost to the exclusion of all other ideas. The varieties of these obsessions of indecision are infinite; anything in regard to which it is possible to raise a doubt may be their incitation. Some patients distress themselves for fear they have been guilty of some impropriety, perhaps some trivial mistake in etiquette; others are equally worried for fear that in some of their acts they may do something in the wrong way-the tying of a cravat or parting of the hair, the form of greeting or parting, etc., may any of them be the subject of their worries. Perhaps the most frequent form is the question that arises as to whether one has performed certain duties or taken certain precautions, such as leaving things in their proper place, locking doors, turning out the gas, etc., and even in the milder types which some of us may have personally experienced, the individual will go back on his tracks over and over again before he can free himself from the obsession. Closely allied to this type are the crack-steppers and the counters, etc., who feel uneasy if they fail to note the number of posts they pass or if they step off certain definite lines in their walks.

In its severer manifestations this doubting psychosis may be a very serious matter; it may occur paroxysmally and be accompanied by precordial pains, headaches, etc. The common delusion of having committed the unpardonable sin in melancholiacs has some resemblance to some of the doubts and mistrusts, but the real melancholiac is a different sort of case. These neurasthenic obsessions are not real delusions; the sub