Psychoses in Adult Mental Defectives: I. Manic Depressive Psychosis

Abstract

Hurd in 1888 described cases of mania, melancholia, folie circulaire and attempted suicide in mental defectives. Ireland in 1898 described three ‘imbecile lunatics’ who were ‘clear cases of melancholia’, and quoted an earlier physician, Wells, who in 1845 had seen ‘attacks of mania in cretins, as well as a peculiar suicidal form of this affliction, which prompts the wretched maniac to attempt self-destruction by throwing himself into the fire’. Clouston (1883) considered that ‘congenital imbeciles may have attacks of maniacal excitement or of melancholic depression—in fact are subject to them’. Kraepelin (1896, 1902) took the view that ‘imbecility may form the basis for the development of other psychoses such as manic-depressive insanity, the psychoses of involution and dementia praecox’. Gordon (1918) stated that mental defectives suffering from depression rarely express ideas of guilt or thoughts of suicide; manics lacked ‘quickness of comprehension of wit or humour or sarcasm’. He noted that depression was more common than mania and that recurrences tended to run true to type. Prideaux (1921) accepted that manic-depressive psychosis could occur in high-grade mental defectives, and drew attention to the increased incidence of conversion hysteria in patients of low intelligence. Medow (1925) observed that mental defectives could manifest all the types of mental illness seen in people of normal intelligence but in the defective mental illness had a silly, fantastic, nonsensical colouring. Neustadt (1928) put forward the view that the typical psychoses of the mental defective were acute episodic states of excitement.