CHAPTER IV

DEFINITION, CLINICAL PICTURES AND METHODOLOGY OF CLASSIFYING MENTAL DISTURBANCES OF THE 16 (TABLE 1)

Symptoms and Phenomena of Mental Distrubances - Clinical Pictures Classification according to Tuke

§ 109 A mental disturbance is any disturbance of the psychic functions.   Psychic functions are emotions, thoughts, memory, imagination, existential identity, sex identity,кαλόν кάγα0όν (kalon kagathon) in the ancient Greek sense, motives of behaviour and so on.

§ 110 The bioneurophysiological mechanism of psychic functions is unknown: also, the bioneurophysiological mechanism involved in the development of mental disturbance is unknown. The causes of mental disturbance itself are as a rule unknown. Thus the question arises: with what criteria will an R of Table 1 be considered mentally healthy or unhealthy at a given moment (bearing in mind that no R suffers from organic lesions or toxic or functional disturbances of any system)?

Careful study of how R is 'activated' by various stimuli reveals that when rejecting stimuli excite his nervous system, they endanger his existential identity/selfpreservation causing him unconscious and sometimes also conscious fear. As a result, R is 'activated' at all levels (emotional, intellectual, motor, etc.) to equilibrate the rejecting stimuli.

Regardless of its quality or intensity, the entire process of R's 'activation' by rejecting stimuli is considered a mental disturbance. Or, more simply, when R's nervous system is excited by rejecting stimuli, the result is mental disturbance.

Whether stimuli acting on R are rejecting or not is for R's nervous system to judge. An observer of R's behaviour is in no position to make such a judgement.

A mental disturbance lasts as long as the nervous system is being excited by rejecting stimuli. When these stimuli stop acting on the nervous system, mental disturbance ceases. As well, if the rejecting stimuli lose their rejecting nature and/or symbolism, then they no longer cause mental disturbance.

§ 111 One can remark that a person who presents mental disturbance may or may not be aware of it. If he is aware of his mental disturbance, he may conceal it from the environment and try to equilibrate it alone. On the other hand, he may seek help from his environment because he feels he cannot equilibrate his mental disturbance alone, or because he believes that he may gain something through his mental disturbance, or both. If a person is unaware of his mental disturbance, his behaviour may be troublesome for the environment. If so, the latter intervenes and, if it wishes, confines the person to a 'special place'. If not, the environment does not intervene.

From the above, then, mental disturbance may be troublesome (a) only for the person who presents it, (b) only for the person's environment, (c) both for the person who presents it and for his environment. It may be, however, that mental disturbance is troublesome neither for the person nor for his environment: in this case one could say that there is no psychiatric problem. The other three cases, however, are the direct concern of neuropsychiatry and no one can deny that the latter is a branch of medicine (despite the opinions propounded by the Anti-Psychiatry Movement).

The 16 cases of Table I are aware that they present mental disturbance which is troublesome both for themselves and their environment. At first they tried to equilbrate the S & P of their mental disturbance alone. Finally, however, they sought neuropsychiatric help.

SYMPTOMS AND PHENOMENA OF MENTAL DISTURBANCE - CLINICAL PICTURES

§ 112 Mental disturbance is characterized by S & P.    Symptoms of mental distur bance are unconscious and sometimes also conscious subjective experiences caused by rejecting stimuli which excite R's nervous system.    Phenomena of mental disturbance are the behaviour R manifests when rejecting stimuli excite his nervous system. A clinical picture is the sum total of the S & P of mental disturbance at a given moment. The particular clinical picture of mental disturbance at a given moment depends on the quality and intensity of the S & P at that same moment. The clinical picture may vary from R to R. It may also vary in the same R at different moments.

§ 113 The clinical pictures of mental disturbance are (a) nervous tension, (b) neurotic S & P, (c) psychoticlike/psychotic S & P. 10

Note: Mental disturbance may:

(a) Present all the clinical pictures in succession, that is, it may begin as nervous tension, develop into neurotic and then psychoticlike S & P and terminate in a psychotic state. Through the inevitable process of conditioning, any clinical picture which R once presented may be reactivated later by seemingly irrelevant stimuli.

(b) Be directly characterized by psychoticlike/psychotic S & P. The sudden death of a loved one, for example, may cause acute depressivelike S & P. As well, there are the S & P presented by autistic children.

§ 114 My efforts to classify the 16 of Table I from a diagnostic point of view proved to be problematic. Systematic observation and study of the 16 revealed that the S & P of their mental disturbance fluctuated periodically both in quality and intensity. More specifically, at some moment every R had presented either S & P of nervous tension or neurotic S & P (obsessional, psychosomatic, conversion hysteria and so forth). Apart from these, R1, R4, R6, R8, R9, R10 and R14 had also presented one or more of the psychoticlike clinical pictures. In short, I found it impossible to make a permanent diagnosis of any R according to the traditional classification of mental disturbances.

CLASSIFICATION ACCORDING TO TUKE

§ 115 My diagnostic difficulties were overcome thanks to H. Tuke's simplified classification ("A Dictionary of Psychological Medicine", 1892). Tuke divided mental disturbances into two large groups.

Group I - Mental disturbances accompanied by toxic or functional disturbances or organic lesions of the nervous system or any other system, as confirmed through laboratory investigation. To this group belong the organic, toxic and functional psychoses of traditional psychiatry, that is, mental disturbances of know aetiology.

Group II - Mental disturbances not accompanied by toxic or functional disturbances or organic lesions of the nervous system or any other system, as confirmed by laboratory investigation. 11 Tuke calls these mental disturbances 'Diseases of the Generative System'. To this group belong the neuroses and psychoses of traditional psychiatry.

In Tuke's group II I also place nervous tension (§ 119), a specific clinical picture of mental disturbance which is not mentioned in traditional psychiatric texts. The 16 of Table 1 belong to group II because laboratory investigation revealed no organic lesion, no functional or toxic disturbance of their nervous system or any other system.

§ 116 No matter what the quality or intensity of their S & P, the 16 of Table 1 are classified as Rejected. This is because the roots of their mental disturbance lie in their foetal life and/or expulsion-birth when rejecting stimuli 'activated' their nervous system.

According to the quality of their intra-uterine experiences, the 16 are further classified into categories and sub-categories (§ 25 - 30).

10 For explanation of the term 'psychoticlike/psychotic' see § 127.

11 As our knowledge of bioneurophysiology expands, the mental disturbances of Tuke's group 11 will gradually move to group 1.