One turns with quite a degree of relief to the momentous work of
Birnbaum[13] on the Psychoses of Degeneracy. As far as can be
ascertained the author does not endeavor to subdivide his degenerative
states into so many types and forms. According to him, the essential
characteristics of the degenerative psychoses--namely, the extraordinary
determinability and influence which outside impressions have upon the
disorder, the mode of genesis and the psychological evolution of the
delusions, etc.,--may be attributed to the essential ear-marks of the
degenerative character; that is, to the exaggerated auto-suggestibility,
the great instability of the existing conditions and mental pictures,
the disharmony between the perceptive and imaginative capacities and the
preponderance of a lively fantastic coloring to the dry thinking of
these individuals. They do not form disease processes of a definite
characteristic form, but episodic psychotic manifestations on a
degenerative soil, and the manifold phases of the collective forms are
to be considered as repeated fluctuations about the psychic equilibrium
of these individuals. He further noted that the symptomatology of these
disorders remained limited to a relatively well systematized delusional
fabric, which, however, in contradistinction to paranoia, does not
persist for any length of time, but disappears for certain definite
reasons. They do not form any typical symptom-complex. The delusional
ideas may take on any character; hallucinations may occur in all fields
of the sensorium; consciousness may or may not be clouded, but is
usually so in the beginning of the disorder. Recoveries are as a rule
gradual, but may set in quite suddenly. Insight may or may not be
present. The course of the disorder, like its symptomatology, offers
nothing of a definite, characteristic nature.
Thus we see that the distinguishing feature of Birnbaum's degenerative
psychoses does not lie in their mode of appearance, in their
symptomatology, but in the mechanism of their evolution, and, above all,
in their total dependence upon extraneous influences. They are typical
psychogenetic disorders, the psychic etiology of which is potent not
only in the incitation of the processes, but in the modeling and
fashioning of them. Although Birnbaum notices the close relation that
exists between these psychoses and the hysterical psychotic
manifestations, he would separate them distinctly from hysteria.
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