Show description

A number of things contributed to this redistribution, such as resistance to humoral pathology, and its terminology; more detailed observation (as a side effect of growing institutionalization); and rationally inspired expectations regarding psychology’s ability to influence mental illness [66]. The first line of demarcation was the idea of partial insanity itself. Some melancholics exhibit no signs of insanity (delirium) whatsoever; thus none of their thoughts and ideas would be regarded as psychotic in the modern sense.

The aim of therapy was to teach patients to adopt a different attitude toward their symptoms. In addition, Jones stressed the reality of intolerance to exertion, for which extensive physiological studies failed to provide an explanation. He therefore spoke of an effort phobia. Jones’ investigations had demonstrated that effort phobic patients quit exerting themselves long before they reach their physiological limit, as expressed by a slightly smaller increase in the lactate level relative to a normal control group following the subjective maximum of exertion.

Such inhibition could, however, also be psychogenically induced. In practical terms, there were all kinds of transitional states between the two major forms of melancholia. The difference between 16 Glas these states lay in the relative degree to which mental and organic components were involved in the origin of the inhibition. This shows that the ups and downs of 19th-century melancholia, as a concept, were determined by a variety of different factors. In addition to attempts to distinguish new forms and the pursuit of ever-more precise classification, there were also advocates of continuity, who searched for transitional forms between the diverse clinical pictures.