secretly active in plotting and scheming against him, the accused.
In this artificially created world he lives with comparative ease, and
has thus succeeded in reaching a proper adjustment to the situation.
The most interesting part of it all is that this so well-organized and
apparently fixed delusional system may disappear at once and the various
false ideas may become entirely corrected as soon as the provocative
agent which is at the bottom of it all is removed. This is a fair
example of what has been termed an acute prison psychosis, and occurs
with considerable frequency among prisoners awaiting trial. Naturally,
these psychoses, being, as they are, psychologically motived, are
extremely variable in their manifestations, but at the root they are all
alike and impress the observer as something entirely different from the
pure endogenous mental disorders. They are all psychically evoked
reactive manifestations of a particularly predisposed constitution to
definite deleterious environmental conditions. Some of the cases
reported in the first paper of this series are good examples of this
type of mental disorder.
We owe our knowledge of these disorders to the contributions of Reich,
Moeli, Kutner, Ganser, Rish and others, authors who, although describing
a more or less identical symptom-complex, have given to it different
names, such as hysterical stupor, Ganser symptom-complex, catatonia of
degenerates, etc. The distinguishing features of this disorder are its
psychic origin, that is, its development in consequence of some strongly
affective experience, and its high grade of impressionability to things
in the environment which may at any time suddenly cause a complete
transition from deep stupor to normal manner and behavior.
The symptomatology consists of an acute delirioid, hallucinatory
episode, usually followed by a more or less complete amnesia which may
go back far enough to include the experience which provoked the
disorder. Such delusional formation as takes place after the
disappearance of the fulminant symptoms may well be considered as part
of the repair process, a mechanism which in most instances reflects the
individual's endeavor to adjust himself to an unpleasant, unbearable
situation, and must not be looked upon necessarily as an indication of
the progressiveness of the disorder.
As we have stated before, complete correction of all delusional ideas
may suddenly take place upon the removal of the causative factor at the
bottom of the entire situation.
As to the treatment of this acute prison psychotic complex
theoretically, we should have no difficulty in deciding this question.
We are dealing with the sequelæ of some definite situation, and the
removal of that situation may be, and actually is, in most instances,
sufficient to bring about recovery. When we come, however, to deal with
concrete instances in daily practice, the problem does not lend itself
so easily to solution.
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