se?
Many more instances of similar nature could be cited in this case.
Another feature which removes all doubt of the psychogenetic nature of
this disorder is the important part which the mental experience which
was active in the production of the disorder played in the fashioning
of its symptomatology. I alluded before to the patient's answer to the
question of whether he heard voices.
The disorder itself, as far as the symptomatology is concerned, is not
absolutely typical of any one of the acute psychogenetic states. It
partakes of Kutner's "catatonic states in degenerates" as well as
Raecke's confusional hallucinatory disturbances in these individuals.
That the patient can be classed as one having a degenerative soil is not
at all certain in this case.
I have considered briefly the importance of a proper recognition of
these cases from the viewpoint of rendering a proper prognosis. There
is another important question which must be discussed in connection with
these cases and that is the question of malingering. Picture to yourself
an individual, who, to all appearances, has led a normal existence, and
never showed anything mentally which might be considered pathologic. He
commits a crime, and upon being arrested or upon being placed on trial
for his offense, suddenly lapses into a condition of apparently complete
dementia. The man, who formerly showed nothing in his conduct and
behavior indicative of a mental disorder, suddenly changes into a state
where he does not know his name, age, or his whereabout. His answers to
questions are irrelevant and of a remarkedly silly coloring. He begins
to act in a childish, affected manner, executing many silly, meaningless
acts, or he may break out in a wild furious excitement, loudly
proclaiming his innocence, and threatening those who arrested him. In
addition to this, it is noted that this apparently pathologic condition
can be definitely influenced by using strict and positive measures. The
untidy habits of the patient may be corrected by urging or threats. The
man who has been mute and refuses to eat can be made to talk and eat
voluntarily by threatening him with tube-feeding. Furthermore, in the
midst of this apparently total dementia, total blocking of all thought
processes, the patient frequently surprises those about him by very
sensible remarks of a very clever and pertinent nature, indicating that
although apparently oblivious of his environment, he knows what is
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