This article throws light upon the three main forms of mental disease that lead to abnormal behaviour. The forms are: 1. Psychoneuroses 2. Psychoses 3. Mental Retardation 4. Anti-Social Personalities.
Form # 1. Psychoneuroses:
Page (1976) holds that Psychoneuroses are relatively mild personality disorders that distress and inconvenience the patient, but do not disrupt his social adjustments and interfere with his every day activities to the point of necessitating supervision and compulsory commitment to a mental hospital.
The patient does not loose contact with the reality and his personality remains intact. Psychoneurotic patients are aware of what they are doing. They understand their mental troubles and difficulties. They can distinguish right from wrong. Their behaviour is not a source of danger to others and rarely offensive. Such illness may or may not impair their output or performance.
Neurotics do not differ from normality in kind, but only in degree. No clear distinction can be made between the normal and the neurotic. Most of us, the normal, can be said neurotics at times. Sometimes, we become sorry, upset, depressed and demonstrate various neurotic symptoms. But this is only temporary while neuroses are permanent.
The chief characteristics of a psychoneurotic are anxiety. This anxiety may either be directly felt by the organism or it may be free floating. The neurotic may control them consciously or unconsciously through the use of various defence mechanisms.
Psychoneurotic reactions are commonest modes of faulty response to the stresses, strains and frustrations of life. The inner tensions and anxieties arising out of confused and unsatisfactory experiences either during the early childhood or later on hinder and affect the future adaptations of the individual. Consequently the inter personal relationship of the neurotic becomes pathological.
Excessive use of defence mechanisms, such as repression, dissociation and various maladaptive behaviour reduces peace and happiness considerably. Thus, neuroses in short are a kind of mild mental disease of which the patient is conscious. He never loses touch with the reality and like normal human beings maintains his social relationship.
A psychoneurotic patient may be highly disturbed by a morbid fear of travelling in a train or a bus or he may be unable to go further a few yards from his own door, but he does not know why. Once a student studying in the inter science class came to the author for psychological counselling and advice.
His primary trouble was that for the last one year he was having this morbid desire to wash his hands all the times as he felt that his hands are dirty and full of germs which might lead to infectious diseases. He further stated that the more he washed his hand he had a stronger desire to wash further and further.
This thought was so persistent that he could not concentrate in his studies and whenever he started writing notes, he felt that the notes were full of germs. So he could not proceed on his writing either.
The author came across a gentleman who was very much interested in Freud and psychoanalysis. He used to take a cup of tea in a very peculiar manner. First he would disinfect the border of the cup and then will take the tea without touching the border of the cup.
Not only that, he washes his hand, handkerchief etc. many times a day. A neurotic becomes irritable and always complains of chronic fatigue. In such people, the harmony of the Id, Ego and Super ego is broken.
A neurotic is distinguishable from the normal except in that though the reactions of normal and neurotics are same under emotional stress, the reactions of the normal are appropriate to the situation and are of short duration. On the contrary, the reactions of the Psychoneurotic are not appropriate to the actual situation and such reactions may continue persistently for months and years.
In case of normal person, however, reaction to an emotional shock is temporary. For instance, following the death of the only son, a normal person may not be able to tolerate the strain and adjust with the circumstances regaining control over himself and after a short period the symptoms disappear, while a neurotic may suffer permanently and his symptoms do not disappear without treatment.
However, in a neurotic there is no gross disorganization of personality, intellect and social habits and no significant organic pathology. Rapport is maintained with reality and society. Speech and thought processes are logical and coherent.
Behaviour is in conformity with social demands. Such people do not interfere with the general welfare of others. The neurotic does not lose touch with reality. In short, the neurotic does not require hospitalization.
A neurotic is an accepted, self supporting, participating member of his community free to come and go as he pleases. He is also sensitive to changes in the external environment. Normal individuals have fear for thieves, germs and diseases. But they do not wash their hands persistently and do not disinfect or sterilize their glass and utensils before taking water or preparing meals like the neurotics.
The normal of course take reasonable precaution to avoid infection. A neurotic similarly may show morbid fear to a spider and the cause of the fear is not known to him. But to a normal person, the causes of his fear are always known. Anxiety neuroses, Hysteria, Phobia, obsessive compulsive neuroses etc. come under this type of mental disease.
Form # 2. Psychoses:
Psychoses are a severe form of mental disease. Different forms of popular insanity come under this category. The chief symptoms of a psychotic involve extreme personality disorganization and loss of contact with reality. A psychotic is sharply distinguished from the normal individual by the bizarreness of his actions, the incoherence of his speech, the absurdity of his hallucinations and his general mental confusion.
A psychotic experiences hallucinations of different types such as taste and smell, sound and touch. Hallucinatory gratification of needs of the psychotic patient shows the characteristics of the infant who has not been able to distinguish between the inner and the outer world.
The psychotic is specially marked by loss of contact with the social world. He withdraws from reality to his private world. His behaviour and thoughts are unaffected by rules of logic. His behaviour is too unreasonable and inappropriate to be understood by normal men.
Thus, in short, a psychosis refers to severe mental disorders that disintegrate the personality and disrupts the individual’s interpersonal as well as social relationship. Contrary to the neurotics, it is necessary to hospitalize psychotics as they are unable to take care of themselves.
Besides, they become a danger and threat to the welfare of the society by creating disturbances, being hostile and violent. They are insane as recognized by law and not legally responsible for whatever action they commit.
According to Freud, the chief difference between neuroses and psychoses lies in regression and disorganization of personality. This category of mental abnormality includes affective reactions, paranoid reactions and schizophrenic reactions.
All the psychological functions like perception, learning, memory and imagination become pathological. But in case of neuroses only a part of the personality, i.e., the emotional aspect is affected while in Psychotics there is total disintegration of personality. A psychotic distorts reality and becomes disoriented towards persons and things in the external world.
He has no proper idea or knowledge of time and place which make his personality more and more disordered than a neurotic. Further, a psychotic unlike the neurotic does not know what is wrong with his behaviour and responses.
According to Freud, the chief difference between neuroses and psychoses lies in-regression, and disorganization of personality. In a psychotic there is severe conflict between the Id, Ego and the Super ego and his personality is permanently impaired.
Page (1976) remarks that in psychoses; normal inhibitions and cultural restraints are several and the patient indulges in whims and phantasies unchecked by rules of logic, common sense and social pressure.
A psychotic’s behaviour is coloured by delusions and hallucinations which he considers to be very real. Because of these hallucinations and delusions he claims to be an emperor, a cinema star, a multi-millionaire or above all God. The common people mock at him when he talks like an emperor or behaves like a royal king; but he does not understand the cause of their mockery.
In his emotional reactions, the psychotic does not show any regard for reality. There may not be any apparent relation between the stimulus and their response. A news which causes laughter among all, may bring tears or sadness in the psychotics. Without any apparent cause, they become suddenly excited, depressed, violent and irritable.
Thus, a psychotic patient is more often than not confused his thought process is completely disorganized, retarded and ineffective. His memory fails and he cannot grasp and understand new materials. In short, there is permanent impairment of total personality.
A psychotic lives in his private world. Real world, its rules, regulations, standards and norms have no implication, no value for him. A psychotic takes his dreams, imaginations and delusions as real and strangely enough strongly believes that they are real.
If he imagines that he is the President of India or Maharaja of Jaipur, he strongly believes that he is so and so and behaves accordingly. No amount of persuasion will help him to give up this belief which is only a delusion. To a normal person, a dream is a dream. But to a psychotic a dream is a reality; a fantastic imagination is a practical and true fact.
Case history:
An old lady developed a morbid fear that there is a constant sound inside her stomach created by some spirits. At times, she was suffering from severe depression and guilt feeling and made many unsuccessful attempts to kill herself. Thus, there is a long and significant gap between a normal and a psychotic, a neurotic and a psychotic.
Form # 3. Mental Retardation:
Page (1976) defines mentally retarded as a variety of individuals who because of subnormal and retarded mental development are unable as children to profit from regular school instructions and as adults are capable of adequate self management or self support.
The mentally deficient are also called feebleminded or mentally defectives. They are the liabilities and responsibilities of the society. Some even take them as a burden of the society. With training and guidance they may show some improvement, but up to a limit after which they do not gain or learn from training, instruction or education.
This category consists of severe, moderate and mild mental retardation. In such cases, low level of intelligence has been there since birth and such types do not significantly indicate any brain disease.
A mentally retarded child may go up to the V grade level but, not more than that. When they grow as adults, can be trained to do their simple routine work to support themselves, but they are incapable of suitable management.
The mentally deficient are definitely not inherently delinquent or immoral but because of their lack of intelligence they often commit small crimes and sex offenses. They do not clearly understand the social implications and repercussions of their action. Such people, children or adult need careful supervision for the betterment of the society.
Lowest grade mental defectives cannot learn to walk, talk or feed themselves. They show less adaptability than the animals. For example, a chimpanzee has better adaptability capacity than a lower grade mentally deficient individual whose mental development is retarded than the chimpanzees. In the mentally retarded personalities organic pathology is obviously present.