Identifier: mentaldiseaseste00cole (find matches)
Title: Mental diseases. A text-book of psychiatry for medical students and practitioners
Year: 1913 (1910s)
Authors: Cole, Robert Henry, 1866-1926
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Publisher: New York, Wood
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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h the self-conservativeinstincts are weakened, there is fortunately not infrequently aloss of will-power and lack of self-confidence, which preventmany of these patients from taking their lives. Another symptom of extreme importance in Melancholiais insomnia, Night after night, unless the patient is treated,he is wretched and sleepless. He is haunted by depressingideas and he reflects upon them. He paces about the room inhis miserable and restless state, and perhaps obtains but oneor two hours of quietude towards morning; he arises againunrefreshed, and is tormented by his feelings of utter wretched-ness and misery. Clinical Varieties.—Melancholia is said to be Acute orRecent when the onset is intense, or when it has originatedwithin twelve months; Chronic when it persists, and thechances of recovery are less certain; and Recurrent whenthere have been previous attacks. The subdivisions that maybe described are— (a) Simple Melancholia.(&) Delusional Melancholia. MELANCHOLIA 109
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o 110 MENTAL DISEASES (c) Hypochondriacal Melancholia. (d) Resistive Melancholia. (e) Agitated Melancholia.(/) Stuporous Melancholia. Simple Melancholia consists in mental depression, whichis more than a passing fit of low spirits, and is in no adequateproportion to the circumstances and bodily health of thepatient. The patient is fully aware of his state and there isno intellectual flaw. He is sleepless and restless, he can onlygive his attention to any occupation with a sense of effort,and he is often a potential suicide. Delusional Melancholia is characterised by the presenceof delusions which have, as it were, crystallised out by dis-sociation, and which serve as an explanation to the patient ofhis depression. The delusions frequently, therefore, arise as afurther state of dissolution in Simple Melancholia ; the patientreproaches himself with some crime or moral offence in thepast, or his ideas affect his religious convictions and he imagineshe is eternally damned. Hypochondriacal

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