CHAPTER IX.
PARTICULAR SYMPTOMATOLOGY.
Moral Perversion. — One of the most definite of the prodromal symptoms and sometimes the one first noted, is that of moral perversion. It is a result of mental disintegration, and may occur years before a marked outbreak of the disease. In other cases 'simultaneously with memory, will and emotional unbalance the morals begin to totter.' Here the symptoms are so obvious that a short time suffices to convince the most incredulous that disease is at work. The patient forgets business engagements, social proprieties, and moral obligations, and he is entirely oblivious of responsibility in any one of them. Positive misdoing rapidly develops; he uses improper language, mistreats wife and family, and indulges in excesses of all sorts. All of these tend to hasten the disease. At necessary remonstrance he creates a disturbance, perhaps uses violence, and is soon adjudged insane.
But in a majority of cases the onset is much more gradual; little by little the character and language change. The moral lapse seems at first a fault of memory, a thoughtless appropriation of trifling articles, that naturally he would not desire, and, perhaps, a seemingly unconscious error of propriety. But a little later he steals in the most open way — anything and perhaps gives it away at once.
These persons are most unconcerned when caught thieving and at once give a reason for their conduct. Often the affections change, and the sense of moral responsibility is wholly lost. This is always connected with the progressive advance of the mental weakness. It has been pointed out that these moral lapses differ materially from the overt acts of those afflicted with so-called moral insanity. In the latter, as the result of a perverted moral sense and defective inhibitory action the instinctive impulses gain ascendency. On the other hand it is shown that in the paretic the deficient moral tone is due to a clouded intellect, the result of incipient dementia. This is quite apparent if we analyze the act, not only in respect to its motive, which is not impulsive but casual, but also in the mode of its accomplishment, which is devoid of forethought and judgment.
<Callout type="important" title="Recognizing Early Signs">Look for changes in behavior such as forgetfulness, inappropriate language, or theft. These can indicate early stages of general paresis.</Callout>
AN ACT OF ARSON IN A PARETIC. S. B., set. 40, laborer, single, tried for burning a stack of straw. Fourteen years before he had severe head injury from a piece of falling coal. (Abstract, Baker, J. Journal of Mental Science, Vol. 35, p. 50.)
INDECENT EXPOSURE IN A PARETIC. A professional man, who was arrested for indecent exposure and fined by the court, retired from the court room and repeated the offense. (Abstract, Stearns, Mental Diseases, p. 478.)
A STUPID THEFT BY A PARETIC. A patient under my care broke into a shop window, abstracted a handful of cigars, and then sat down on the curbstone to enjoy them, when he had sufficient money about him to supply his needs. (Abstract, Berkley, Mental Diseases, p. 174.)
REPEATED PILFERING; MARRIED A MULATTO. A patient, at an early period in his disease, would pick up small articles from store counters and put them in his pockets, and would not miss them when others removed them. He always strongly affirmed that he had bought articles, or that they had been given to him years before. This patient, a physician, had married a mulatto woman two or three years before his friends had him placed under legal restraint. (Abstract, Stearns, of, cit.^ p. 472.)
DISHONEST TRANSACTION OF A RAILROAD OFFICIAL WHO PROVED TO BE A PARETIC. A railroad official, well known for his thrift and business ability, with no previous mental symptoms, went to a small town in western Virginia, where he was known. He took a room at the principal hotel, purchased several properties, and told his friends that a railroad was to run through the place, and that he had bought the properties so as to forestall the projectors of the road, as they wished to locate their depots and offices on these sites. He was so well known for his business acumen that a syndicate was formed by the local people, and the land rebought at an advance of thirty thousand dollars. The man left the town with his gains, which he dissipated within a few days. (Abstract, Berkley, op. cit.^ p. 173.)
THIEVING BY PATIENT EIGHT YEARS BEFORE ONSET OF DISEASE. An old government officer, for eight years prior to his reception in an asylum, had been guilty of repeated abstractions of articles at public sales which he attended officially. After the last theft he was arrested. His physician at once saw that he was mentally affected; pronunciation embarrassed, face 'petrified,' walk heavy; when asked as to the circumstances of his arrest, the patient answered without remorse or shame: 'The people who put me in prison are imbeciles, who know nothing of our professional usages. There is a custom among us, known as the * cote G,' to choose some object of slight value and retain it when taking the inventory.' And with this he took from his pockets a meerschaum pipe and a gold-mounted tobacco pouch. He was pronounced a paretic,
SEXUAL INSTINCT. — In general paresis there is an insane exaltation of the sexual nature in many cases. The sexual power may be weak but the passion very strong. The female betrays much personal vanity and self-consciousness in the presence of men; she is often engaged in matrimonial designs. Frequently, the male patient suffers from the delusion that his wife is unfaithful to him, while he may run into vile excesses himself.
LOSS OF SEXUAL ABILITY IN PARESIS. Loss of sexual ability in one case was among the earliest indications of the disease. (Abstract, Steams, Mental Diseases, p. 472.)
LOSS OF SBXUAL ABILITY AS AN EARLY SYMPTOM. In a case of the writer's experience, the wife mentioned loss of sexual power as an early symptom in the husband, although the desire was stronger than normal.
PERVERSION OF SBXUAL INSTINCT IN PARESIS. Another case, which was in the second stage, displayed little or no natural sexual desire, but at the same time, shamelessly masturbated in the presence of his wife, to whom he was devotedly attached.
HALLUCINATIONS. — Hallucinations of the special senses occur in about half the cases of general paresis. Visual and auditory hallucinations are the most common and according to Mickle are found in forty per cent, of the cases ; next in order, are tactile, gustatory and olfactory hallucinations, which are present in about twelve per cent. Hallucination of all of the special senses is sometimes found in the advanced stages, the patient showing visual, auditory, olfactory, gustatory and tactile perversion, the result of the advancing degeneration of the neurons of the cortex.
The hallucinations of paretics are usually variable, unstable and inconsistent, being less systematized than those of many other forms of insanity. Spitzka compares them with those found in some of the acute insanities, such as in alcoholic insanity and contrasts them with those of paranoia, where they are fixed and systematized. Hallucinations, illusions and delusions are liable to be combined in varying degree, and it is troublesome, if not occasionally impossible in practice, to separate the long catalogue of these perversions into their respective category. Again, prominent delusions may mask the less conspicuous manifestations of the other morbid perversions, and to this fact may be attributed the paucity of hallucinations among paretics that is found in the experience of some observers.
Visceral sense-impressions, scarcely noticed in normal conditions, are vivid in the paretic and become linked with his delusions. Especially is this the case in the hypochondriacal form when, visceral sense-impressions (illusions) are a marked feature of the perversion. Joyful hallucinations accompany the ambitious deliria, while painful ones pursue those afflicted with melancholic depression. In one case, countless frogs were seen by the patient hopping about him, whose intestines bulging out from the vent, had been stuffed into their mouths; another patient heard voices commanding him to kill some one, in order that he might himself be compelled to commit suicide (Spitzka).
Some writers hold that the sense of pain, expressed in groans and cries in the last stage of the malady, is not hallucinatory, but is due to nervous lesions, either central or peripheral, and that the assurance in personal strength, frequently so confidently expressed in the first and second stages, is not a delusion, but more properly an hallucination, due to the morbid perversion of the kinesthetic sense.
The question is sometimes asked whether hallucinations are met with more frequently in the expansive, or in the depressive form of the disease. It seems to be a very general experience that they are oftener found in the latter cases, or it may be, owing to the distressing nature of these hallucinations that they are forced more readily on the attention. Campbell Clark gives a striking example of the uncanny nature of these hallucinations in the depressant form. The patient declared that he had seen in the night his house filled with black dogs, and the noise of their howling kept him awake all night. He had the hallucination, also, that a drowned man was touching him; said that his saliva tasted very bitter and that it was poisoned; that laudanum had been given him; and the doctor had opened him in his sleep; and that he had been blistered with two fly blisters.
Key Takeaways
- Look for early signs of moral decay, such as forgetfulness or inappropriate behavior.
- Recognize the difference between general paresis and other forms of insanity in terms of their symptoms and progression.
- Be aware that hallucinations can occur but are less common than in some other forms of insanity.
Practical Tips
- Keep a close eye on any changes in behavior, especially if they involve forgetfulness or inappropriate actions.
- Educate yourself about the signs of general paresis to help identify it early and seek appropriate medical attention.
- Understand that hallucinations can occur but are less common than other symptoms like memory loss.
Warnings & Risks
- Do not ignore changes in behavior, as they could be indicative of a serious condition like general paresis.
- Be cautious when dealing with individuals showing signs of mental decline to avoid misdiagnosis or mistreatment.
- Recognize that the progression of symptoms can vary widely and may not always follow a clear pattern.
Modern Application
Understanding the early signs of moral perversion in general paresis is crucial for modern survival preparedness, as it helps in recognizing cognitive decline before it becomes severe. While the condition itself is no longer prevalent due to advancements in medicine, the importance of recognizing behavioral changes and seeking medical advice remains relevant.
Frequently Asked Questions
Q: What are some early signs of general paresis that I should look out for?
Early signs include moral decay such as forgetfulness, inappropriate language, or theft. These behaviors can indicate the onset of the disease before it becomes more severe.
Q: How can I differentiate between general paresis and other forms of insanity?
General paresis often shows a gradual decline in behavior and memory, whereas other forms may have more sudden or fixed delusions. The moral lapses are due to clouded intellect rather than perverted moral sense.
Q: Can hallucinations be a sign of general paresis?
Hallucinations can occur but are less common in general paresis compared to other forms of insanity. They are usually variable and inconsistent, unlike the fixed delusions seen in paranoia.