Mental diseases: a public health problemMay, James Vance
Science
Mental diseases: a public health problem
May, James Vance
Mental health services; Psychology, Pathological
In the introduction to the book written by Dreyfus in 1907, Kraepelin
nevertheless expressed the opinion that "These results show that
for the most of these disorders which have been designated as
melancholia there now exists no sufficient reason to separate them
from manic-depressive insanity." This at the time was looked upon as
definitely settling the fate of the melancholia concept and it was
abandoned by some. As a general rule, however, the psychiatrists of
this country seem to have accepted Kraepelin's original description
of the disease as being thoroughly justified. To use White's words,
"Many psychiatrists still believe, although Kraepelin himself accepts
Dreyfus' conclusions, that there is still a place for involution
melancholia distinct from the manic-depressive group."
In his eighth edition Kraepelin[286] discusses melancholia as a
presenile condition and reviews the whole situation in considerable
detail. He shows that symptomatic considerations alone did not guide
him in his original conception of the disease. A great deal of weight
was attached to prognosis and certain forms were separated out and
differentiated from manic-depressive because they tended towards
mental enfeeblement. He calls attention to the fact that Thalbitzer
disputed the integrity of melancholia in 1905, classifying it as a
manic-depressive reaction. After reviewing the findings of Dreyfus he
admits that the conclusions of the latter are in the main correct and
that involution melancholia as originally described cannot be retained
as a definite entity. "The significant fact still remains," he says,
"that single attacks of depression are disproportionately common in
the involution period." Hübner, for instance, found twenty-one single
attacks of melancholia after the fiftieth year of age to only two
single attacks of mania. "The appearance of depressions, therefore,
through the revolutions of this period of life seems to be favored
to a special degree." He again states that he is unable to determine
what rôle is played in the involutional depressions by beginning
arteriosclerosis or the onset of senile conditions. He concludes,
however, that a form of depression, earlier described as melancholia,
is still to be separated from the manic-depressive psychoses although
not entirely clear as to its significance or exact delimitation.[287]
Public-domain text, read in full here on John Shaqi.
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