Review of T. Zichen's 'Psychiatrie f. Aertze und Studierende'

by W.H.R.Rivers

Psychiatric fur Aerzte und Studierende. Prof. TH. ZIBHBN. Berlin : F. Wreden, 1894. Pp. ix. 470.

this work, which forms one of a series of medical textbooks, the author treats diseases of the mind on the basis of the psychological doctrines laid down in his " Leitfaden der physiologischen Psychologie," of which an English translation has appeared. One of the marked features of that book was the thorough-going adherence to what the author called the " association psychology of the English," though his system was distinguished from that of English "psychologists by the importation of the Herbartian notion of the mutual strengthening or inhibition of ideas to which the name of "constellation" was given. The first part of the present book, entitled general psychology, extends over 150 pages, and is devoted to an account of the author's psychology with its application to the analysis of abnormal mental symptoms, and it is this part of the book which will be chiefly interesting to neurologists. In it mental symptoms are considered under five heads as disturbances of .sensation, of memory images, of intellectual feeling tone, of association of ideas, and of action. Under the first heading illusions and hallucinations are chiefly considered, the latter term being limited to those cases in which there is no actual stimulus external to the body. A novel feature is the division of both illusions and hallucinations into two groups: those in correspondence with the general content of consciousness, and those which have no relation to this content, but arise out of latent or half-forgotten memory images. It is doubtful whether this division, though corresponding to a psychological distinction, is one of practical value.

The section on affections of memory images is chiefly devoted to word blindness and deafness, and these conditions support the author in the opinion expressed in his former book, that the memory images have a physical basis different from that of the original sensations—a view which is gaining ground among psychologists.

In the section on affections of intellectual feeling tone, exaltation, depression, and other emotional conditions are considered. Much importance is attached to irradiation of feeling tone, whereby one element of a mental complex with a pronounced painful or pleasurable tone of feeling transfers this tone to the whole.

The next section, on disturbances of association, is an important one. The relation of increased or lessened rapidity of the flow of ideas to the state of feeling is considered at some length, being of importance in its bearing on the classification adopted later by the author. The subject of incoherence or dissociation of ideas is treated in a specially interesting manner; incoherence is regarded as frequently secondary to other psychopathic conditions, such as increased rapidity of flow of ideas, hallucinations or delusions, violent emotions or weak-mindedness; but the author insists on the existence of a primary dissociation, depending on a disturbance of association paths. Such cases of incoherence' are analogous to those cases of aphasia caused by lesions of paths connecting different centres, which may indeed be regarded as special forms of primary dissociation. This primary dissociation may affect not only the train of ideas, but may occur between the sensation and idea causing defective orientation in regard to surroundings, or it may occur between the ideational and motor elements, giving rise to incoherence of action.

In the section on morbid actions, the author refuses to regard such actions as dependent on disturbance of any special will process, and sees in them only the natural outcome of the disturbed sensory or ideational processes.

In the chapters on diagnosis, aetiology and therapeutics, the author shows his close acquaintance with the more practical side of his subject. The chapter on diagnosis has an excellent outline of symptoms as a guide to the examination of patients.

The chief interest, however, of the latter half of the book will be found in the classification adopted. This differs considerably from those most usually met with in England, and chiefly in the treatment of the simple or primary forms of insanity. Professor Ziehen takes the psychological distinction between cognition and feeling as the basis of his classification. The term "mania" is limited to cases in which the general tone of feeling is altered in the direction of pleasure, a condition the true opposite of melancholia when the alteration is in a painful direction. In both mania and melancholia the change of feeling is primary and the intellectual disturbance present is secondary to the state of feeling.

Cases, on the other hand, in which the primary and dominating disturbance is of the cognitive side of mental life, form a group to which the name paranoia is given, and this includes many, if not the majority of the cases which in England would be labelled "mania." This has four chief sub-groups: acute and chronic simple paranoia, acute and chronic hallucinatory paranoia. In the latter forms illusions and hallucinations are the chief symptoms, delusions developing from these, especially in the chronic variety. In the simple forms delusions predominate, chronic simple paranoia corresponding to the chronic delusional insanity of English writers. These four chief forms have their varieties : acute hallucinatory paranoia, for instance, having varieties depending respectively on the predominance of increased or lessened rapidity of mental processes, of incoherence, of exaltation, or of depression.

The book concludes with an excellent series of plates illustrating the various types of insanity. Professor Ziehen may be congratulated on this addition to the text-books of insanity. It is valuable especially for the general coherence -which has been given to one of the most confused branches of medical knowledge, and this coherence is mainly due to its foundation on the basis of a systematic psychology. Whether this psychology is a true psychology is another matter. Whatever views may be held about it it must be acknowledged that it may form a useful basis for the study of mental pathology.