MENTAL ILLNESS. - Morbid states also called phrenopathies, psychopathies, psychoses, which manifest in acute or chronic form with disturbances of the psychic activities, whether intellectual (noopsychic) or affective, instinctive, sentimental (thymopsychic), whenever the brain is altered in its structure or impeded in its function by exogenous morbid causes (traumas, tumors, toxinfections, endocrine disturbances, emotions, etc.) or endogenous ones (degenerative, atavistic, hereditary); the latter, often, by determining a congenital debility and a lesser resistance in the nerve centers, predispose the individual to the action of exogenous causes, so that not rarely the one and the other interpenetrate and integrate in the genesis of the psychopathies.
As regards the causal value of emotions, a careful examination of the patient and of his antecedents always allows one to detect the preexistence of a psychopathic constitution or of the same mental disease already in progress for some time, so that the psychic trauma assumes the value of a revealing element or that of a concurring cause in the determinism of a reactive psychosis sprouted on a constitutionally predisposed ground. The most intimate causes and the pathological anatomy of m. d. [mental diseases], with the exception of a few, are uncertain and imprecise, for some indeed unknown; their classification suffers from this uncertainty, being quite varied according to the concepts upheld by the different schools. In general terms a first generic distinction is admitted into organic forms and functional forms, founded on the concept of the existence, or not, of a demonstrable anatomical alteration supporting their symptomatology.
By way of general guidance, the classification on a clinical-etiological basis adopted by the Statistical Office of Rome for the notification of m. d. [mental diseases] is reported; it rests on that of Kraepelin on a clinical-etiological basis. Many others exist, since every author, studying m. d. [mental diseases] from his own points of view, arrives at different nomenclatures and framings, dissimilar, however, often more in external form than in substance. Phrenasthenia (v.) or oligophrenia (with or without evident lesions of the brain); psychopathic personalities (moral insanity, paranoia and querulous delusion, prison psychosis, sexual psychopathies, hysterical, neurasthenic, phobic psychoneurosis, etc.); epileptic psychoses; affective psychoses (depressive, manic, manic-depressive); dementia praecox (schizophrenia, in its various forms); endogenous toxic psychoses (linked to internal factors: endocrine, constitutional, metabolic); exogenous toxic psychoses (from voluntary or medicinal intoxications); infective psychoses (in relation to syphilis, tuberculosis, typhus, encephalitic viruses, etc.); senile psychoses (involutional, arteriosclerotic, etc.); psychoses from organic encephalopathies (traumas, tumors, etc.).
The uncertainty of the causes and the consequent imprecision in classification are inevitably reflected in the therapy of the psychoses, which, quite often, particularly for the more obscure ones, is limited to a purely symptomatic plane. On the other hand it cannot be denied that, particularly in these last years, notable progress has been achieved with regard to treatments and not negligible results obtained by means of the recent methods of shock (insulin, electric, cardiazol, acetylcholine, etc.) mainly in schizophrenia and in the dysthymias; with malariotherapy and insulin in progressive paralysis. With such methods of treatment one can often arrive, if not at true recoveries, at improvements such as to allow many psychopaths, in the past fatally condemned to chronicity, to be restored to family and society, even to a working activity. The prognosis remains to this day unfavorable for cases with a severe course, resistant to any intervention, and in degenerative and involutional psychopathic pictures. In the forms held to be functional in basis, particularly the psychoneurotic ones (hysteria, psychasthenia, anxiety forms, neurasthenia or alarm syndrome, etc.) and where the psychological-emotional factors prevail, psychotherapy (v.) of psychoanalytic orientation or otherwise, narcoanalysis (v.) and prolonged sleep recently introduced into therapy are widely used, possibly in conjunction with medicinal treatments. Most recent, finally, is the surgical treatment of the psychopathies, which with lobotomy, lobectomy, topectomy, comes to isolate from its connections or even to demolish regions more or less extensive of the cerebral cortex; it derives, developed and expanded in its applications, from the prefrontal leucotomy practiced for the first time by Moniz in 1936 and still in use. Such operations are at present frequently performed, with varying results, in the treatment of obsessive psychosis, of the cyclothymias in general, of schizophrenia, of epilepsy, of post-encephalitic syndromes. No less important than treatment is the prophylaxis of m. d. [mental diseases], especially with regard to alcoholic psychoses and syphilis of the nervous system, carried out by means of appropriate propaganda, outpatient visits, repeated sanitary and biological checks, with the aim of preventing and of catching the psychopathies, particularly the toxic and infective ones, in their initial phase, when treatment is more useful and the arrest of development, otherwise irreparable, is easier.
As regards the state of intelligence, the modalities of character, moral responsibility in m. d. [mental diseases], see the respective entries, in particular the various "psychoses."