Another useful classification may be made by a combination of the classifications of Esquirol and Greisinger. It is used by some of our lecturers on mental disease. 258. Recurrent Mania. Monomania of Pride. Monomania of Vanity. Monomania of Suspicion. Erotomania. Dipsomania. Kleptomania. Pyromania. Homicidal Mania. Acute Melancholia. Nostalgic Melancholia. Dr. Skae's and Dr. B. Tuke's Classification.-It may interest the reader to have his attention called to a classification which has found favor with a certain school of medical psychologists in this country. The scheme was propounded by Dr. Skae, and has been modified by one of his pupils. While we quote the classification, we cannot but regard it as in many aspects unsatisfactory, and open to the many faults which have been found with it by Professor Laycock' and other writers. Professor Laycock's "Nosological Index," first published in his work on "Medical Observation and Research," 2d edit. p. 342, although eminently suggestive, is of to complex and theoretical a character to be available for practical purposes. Class I.-Insanity resulting from arrested) or impaired development of Idiocy, congenital and acquired. the brain. 59. These Classifications Criticized.—[44] In the first of these methods the mental peculiarities of the patient are the ground of classification; in the latter the mental symptoms are put aside and disregarded, and the forms of disease are classified according to their supposed pathological causes and the relation of these causes to the bodily organism. No classification is perfect. We must endeavor to obtain that which will be most useful to those who would treat disease, and to those who would understand in what cases mental aberration or defect will modify the relations of an individual to his fellow-countrymen, to his property, and to the State. The classification quoted above, which is based upon the pathological cause of the disorder, has a look of science about it which will deceive many. It is a fact proved by the everyday experience of those who have to do with mental disease that we find many patients whose insanity, although resulting from exactly similar causes, differs the one from the other in every possible particular. Besides, is it not evident that, to arrive at any conclusion with regard to the cause, we must take into consideration the mental peculiarities of the patient, and thus rise to the classification which pretends to be independent of mental symptoms, through the very classification of peculiarities of mental condition which it pretends to discard? In the above classification, it is obvious that there are grave mistakes, which present themselves even to those who are only partially acquainted with nosology. Thus, to place Idiopathic Insanity as a sub-class under Idiophrenic Insanity shows how weak the system is. A classification which is understood to be framed according to pathological causes has taken care to have a class where all maladies which cannot be thus classified are to be placed. How large this class is it is impossible to say, but any classification which has under it a class which it is impossible to classify seems to us as satisfactory in its way as an argument which demands the conclusion as a datum. Again, under Class 3, Sympathetic Insanity, we find the subclasses Climacteric Insanity and Post-connubial Insanity. To pretend to classify diseases according to their pathological causes, and then to state as a cause a whole system of life, or a bodily condition existing for years, is surely unphilosophical. It would be as correct to give as a sub-class "insanity arising from previous conduct." But the errors are too many to allow us to do them the justice of pointing them out, and too obvious to require it. 2 60. Dr. Maudsley's Classification.-It may not be useless to note one or two other classifications of insanity. Thus Dr. Maudsley adopts the following: I. Affective or Pathetic Insanity. 1. Maniacal Perversions of Affective Life (mania sene delerio.) 2. Melancholic depression without delusion (simple mel ancholia.) 3. Moral Alienation proper. Approaching this, but not reaching the degree of positive insanity, is the insane temperament. 261. Dr. Hammond's Classifications.-Again Dr. Hammond, in his valuable work on Diseases of the Nervous System, gives the classification which was agreed upon at an international congress which met at Paris in 1867. It is as follows: I. Simple Insanity, embracing Mania, Melancholia, and Monomania, (thus negativing the claims of Monomania to be considered a distinct disease,) Floating Insanity, Moral Insanity, (whose independent existence is thus also negatived,) and Dementia consequent on the above types. II. Epileptic Insanity. III. Paralytic Insanity, which is treated as a distinct disease. IV. Senile Dementia. But although Dr. Hammond refers to the classification just quoted, it can scarcely be with entire approval. Indeed, it is difficult to see upon what principle such a grouping could have been made; and it seems to us entirely illogical. Dr. Hammond's own classification has greater merits. He divides insanities as follows: I. Perceptional Insanity, "characterized by the tendency to the formation of erroneous perceptions either from false impressions of real objects, (illusions,) or from no external excitations whatever, (hallucinations)." 1 See Physiology and Pathology of Mind. London: 1867. 2 New York, p. 337. II. Intellectual Insanity, characterized by delusions.' IV. Volitional Insanity. V. Mania. VI. General Paralysis. VII. Idiocy and Dementia. This classification has been adopted by Mr. Dudley Field in his essay on "Emotional Insanity," in so far as the first four classes are concerned. In this way he would, we suppose, regard mania, general paralysis, idiocy, and dementia as properly belonging to one or other of the first four classes. For all practical purposes, however, perceptional insanity might be left out of consideration, as it is according to Dr. Hammond productive only of illusions and hallucinations, which if they are irremovable by evidence, or really indications of insanity, at once pass into the category of false beliefs or delusions, and indicate the existence of lesions in the ideational centres. We come, then, ultimately, only to three forms of insanity-that which is connected with the emotions or feelings, that which is manifested in relation to thoughts or ideas, and that which affects the volition or will. 2 62. Dr. Bucknill's Classification.-One of the most recent attempts at classification is that of Dr. Bucknill, whose position as one of the ablest leaders of medico-psychological thought in this country entitles his classification to an attentive consideration, which it should have commanded by its own intrinsic merits. Dr. Bucknill's classification was originally published in the "Lancet," but it is now appended to Drs. Bucknill and Tuke's "Psychological Medicine." It purports to be founded on pathogenetic relations of morbid mental states, while under these are grouped the various ætiological forms of insanity as "genera," these genera being Dr. Hammond, in distinguishing illusions and hallucinations from delusions, said: "Illusions and hallucinations may exist, and the individual be perfectly sensible that they are not realities. In such cases, the intellect is not involved. But if he accepts his false perceptions as facts, his intellect participates, and he has delusions. A delusion is therefore a false belief." Albany Law Journal, 3 May, 1873. * 3d ed., p. 801. |