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Page 30
These are a few examples of the perturbations of conduct common to
neurotic sufferers and the diseased in mind. One perceives that the same
laws relating to the diminution of force and the lowering of the
psychological tension intervene in the same way with the one as with the
others. The distinctions, which have been established for social reasons
and practical conveniences, no longer exist when one tries to find, by
analysis of the symptoms, the nature of neuroses and psychoses.
The latter reflection shows us, however, that in certain cases, at
least, there is a certain difference in degree between neuroses and
psychoses. The evolution of the human mind has been formed by degrees,
by successive stages, and we possess in ourselves a series of superposed
layers which correspond to diverse stages of the psychological
development; when our forces diminish we lose successively these diverse
layers commencing with the highest. It is the superior floors of the
buildings that are reached first by the bombardments of the war and the
cellars are not destroyed at first; they acquire even more importance,
as people are beginning to inhabit them. Well, according as the
depression descends more or less deeply, the disorders which result from
the loss of the superior functions and the exaggerated action of the
inferior ones become more and more serious and are appreciated
differently. The superior psychological functions are, in my opinion,
experimental tendencies and rational tendencies. They are tendencies to
special actions in which man takes in account remembrances of former
acts and of their results, in which he enforces on himself by a special
effort obedience to logical and moral laws. A little fatigue and a
slight degree of exhaustion are sufficient for such an action to become
difficult and impossible to prolong for a long time. Furthermore, the
disorders of the experimental conduct or of the rational conduct are
very frequent. These disorders only reach the superior actions which are
not absolutely necessary to the conservation of social order. They can
be easily repaired by inferior acts: if the man does not obey pure moral
principles, at least he can conduct himself in appearance in an
analogous manner through fear of the prison. Also, these disorders of
the superior functions are considered as slight; they are called errors,
or faults, and it is admitted that the subjects remain normal beings.
At the other extremity of the hierarchical series of tendencies the acts
are simply reflex. When the disease descends to this level, when the
elementary acts can no longer be executed correctly, we do not hesitate
either, and we consider these disorders (related with known lesions) as
organic diseases of the nervous system. But between these two terms we
note disorders in behavior which are more difficult to interpret. These
disorders are too grave and too difficult to modify by our usual
processes of education and punishment for us to consider them as mere
errors or as moral faults; they are variable; they are not accompanied
by actually visible lesions and we have trouble in classing them among
the acknowledged deteriorations of the organism. There is the province
of neuroses and psychoses, intermedium between that of rational errors
and that of organic diseases of the nervous system. It corresponds to
the disorders of medium psychological functions, to the group of these
operations which establish a union more or less solid between the
language and the movements of limbs and which give birth to our wills
and beliefs.
Can one establish, in this group, a distinction between neuroses and
psychoses that rests on some more precise notion and that is not limited
to distinguishing them in a legal point of view? A more profound
knowledge of the mechanisms of the will and belief would perhaps permit
us to do so. We are capable of wills and beliefs of a superior order
when we reach decision after reflection. The operation of reflection
which hinders tendencies and maintains them in the shape of ideas, which
compares ideas and which only decides after this deliberation,
constitutes the highest form of the medium operations of the human mind.
Lower, still, there exists will and belief, but they are formed without
reflection, without stoppage of ideas, without deliberation; they are
the result of an immediate assent which transforms verbal formulas into
wills and beliefs as soon as they strike the attention, as soon as they
are accompanied by a powerful sentiment. The immediate assent is the
inferior form of these tendencies.
If one wished to establish a scientific distinction between neuroses and
psychoses, I should say, in a summary fashion, that in neuroses the
reflection alone is disturbed, that in psychoses the immediate assent
itself is affected. The shrinkage of the conscience, doubts, aboulias,
obsessions, scruples are always disorders of the reflected will and
belief. On the contrary, irresistible impulsions, deliriums,
indifferences which suppress desires and only allow elementary
agitations to subsist, show alterations in the immediate assent, in the
will, and the primitive belief and must be considered as psychoses.
Below could be placed the disorders of elementary intelligence, the
disorder of the perceptive and social functions which characterize the
mental deficiencies of imbeciles and idiots. One might also distinguish
these disorders according to the degree of depth the destruction of the
edifice has reached, according to the more or less distant state of
evolution to which the patient goes back. But these psychological
classifications are purely theoretical, and in practice many other
factors intervene which oblige us to consider such a patient as
incapable of doing any harm and such another as dangerous; this is the
only difference to-day between neuroses and psychoses. Later on, without
doubt, we shall be able to substitute for these simply symptomatical and
psychological diagnostics, some etiological and physiological
diagnostics. We shall be able from the very outset to recognize that a
disorder, in all appearance slight and which is not deeply set, presents
a bad prognosis, and we shall be able to foresee a serious and deep
psychosis in the future. To-day, without doubt, one can often
distinguish from the outset the future general paralytic from the simple
neurasthenic. But in the actual state of science this ability to
distinguish is not frequent and the future evolution of a depressed
state can scarcely be foreseen with precision.
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