13.  MENTAL PROBLEMS AND BRAIN DISEASES

For quite a number of days The Man had been behaving oddly. Several times he had left the cave and gone out into the jungle, which more than 50,000 years later would be a peaceful countryside in Europe. Now, in these prehistoric days, The Man was greatly troubled by a strange confusion. Also there was a pain in his head that never seemed to leave him.

Anxiously The Woman watched and waited, avoiding him when he returned from his short trips out of the cave. She worried because there was little food. The small ones were hungry.

Once, The Man had brought food home regularly from his trips. He had roughed her with his large, strong hands in his affection. He had taken her and made her know his pleasure from her. This was as it should be.

But now The Man was changed. Sometimes he stumbled a little as he walked. Sometimes he treated her with a brutality that was devoid of affection. Once he had fallen to the ground of the cave and had become stiff, trembling, and frightening to behold. Foam had come from his mouth.

Now he had not left the cave for two days. He lay silent, his eyes staring vacantly into the light at the mouth of the cave, his breathing heavy. He took no notice of her. He ignored the young ones.

Finally, in desperation, she crept from the cave and ven­tured beyond the closeness that marked her bounds of safety. In mortal fear of the animals, the serpents, and the dangers that only The Man could face, she followed a trail to another cave. Inside she found aid.

A medicine man was summoned and told about the behav­ior of the woman's cave man. He nodded wisely. He told about an evil spirit that was locked in the ill cave man's head. He would cure him.

He glanced about him and selected four men. With The Woman they traveled back to her cave and there The Medi­cine Man examined the unresponsive patient. He stared into The Man's vacant eyes. He listened to the breathing. He poked and pummeled. There was no response—only the va­cant staring, the loose mouth and limp arms.

"Hold," The Medicine Man directed to his companions, pointing to arms and legs. He motioned for them to stretch the man out on the floor of the cave. Then he carefully selected a thin, sharp slice of rock and placed it against the ill cave man's skull. With a heavy, round stone he tapped against the rock chisel as he began to cut a hole into the skull to let out the evil spirit.

Traumatic pain of the primitive surgery brought the patient out of his lethargy, but strong hands held him fast. The Woman cowered back in the darkness of the cave, the small ones clustered behind her. The Medicine Man tapped and chiseled, tapped, chiseled, and scraped.

Finally he was finished. Something had happened to the cave man. He no longer resisted the surgery. He breathed heavily, limp, with eyes closed.

The Medicine Man nodded to his helpers. They released the arms and legs and stood to stare down at the patient and at the wound in the head. No one could see the evil spirit that was released, but now it was out. Perhaps the sick man would be well again.

Without glancing at The Woman they stalked away and went about their business, following The Medicine Man who strutted a little in his pride of accomplishment.

We have no way of knowing if the cave man recovered fully, but we know that he may have lived on because skulls of that age, found much later, disclose healing around the trephine operation. And although there were no "evil spirits" to be released, a certain amount of pressure may have been relieved, occasionally, to effect relief for the prehistoric sufferers.

At any rate, there is little doubt that prehistoric trephining was the first surgery performed, and it is equally interesting to contemplate that it most probably was performed to relieve conditions that probably must have been associated with the brain.

Holed skulls have come to light in almost every part of the world where scientists have sought to uncover the secrets of the past. They have been found in Peru, France, Austria, Poland, Russia, Germany, Spain, England, the South Pacific, Caucasia, Algeria, the Americas and in the lands of most of the ancient civilizations.

The oldest known scientific surgical treatise, the Edwin Smith Surgical Papyrus, believed to have been written 3000-2500 BC, is the first place the word "brain" is recorded, with a description of its convulsions and membranes.

The early operations described above—trephining, or cut­ting a hole in bone of the skull—usually went no further than the bone cutting. Occasionally a brain abscess might be re­lieved by such primitive surgery, but otherwise the favorable results of such operations probably were few and far between.

Today neurosurgeons can operate in almost any part of the brain with relative safety, and they know what they are at­tempting to accomplish.

Yet it was only a few decades ago that brain surgery was still unusual and regarded by most laymen with awe and a degree of fright.

Recently, Keith Olmstead, a man in his thirties, began to suffer from frequent headaches, vomiting, and certain disturb­ances of vision. He went to his family physician who exam­ined him thoroughly and asked a great many questions.

Olmstead explained that he was intensely worried by his condition as it sometimes affected his work as an airplane mechanic at the local airport.

The physician sent Olmstead to a neurosurgeon.

"I'm going to give you some tests," the surgeon explained.

"What do you think is wrong with me?" Olmstead asked fearfully. "A brain tumor?"

"Don't look so frightened," the surgeon said. "Even if there is one, and surgery is necessary, your chances are excel­lent. About eighty to ninety per cent of our patients recover. And—in your case—we're not even certain it's that. But if it is, we probably have it early."

"What kind of tests will you use, Doctor?"

"If it's a tumor, I must know exactly where it is. We'll start, probably, with an ordinary X-ray. That may be enough in itself. We may want a pneumo-encephalogram—in this test we replace some of the fluid in the spaces of the brain with air that acts as a contrast agent to outline chambers of the brain on an X-ray film."

He then explained that a brain-wave test, known as an electroencephalogram, might be used. The spinal fluid would be examined. An arteriogram would visualize the blood ves­sels in the brain. There might also be some studies that would entail using radioactive substances.

Keith Olmstead had his tests, and it was ascertained that he had a brain tumor. Surgery was advised and Olmstead went into a hospital.

Dr. Rayson, the surgeon, decided upon a general anesthetic for the operation. In the first step of the operation, Dr. Ray-son incised the scalp and laid back the skin. With an electri­cally powered drill, he drilled a pattern of holes in the under­lying skull. The bone was then cut between the holes so that a section of the bone could be detached to expose the membrane covering the brain.

An incision was made in the membrane (dura) so that the brain was exposed. The surgeon made a careful examination and ascertained that the tumor could safely be removed. Taking great care not to damage normal brain tissue, he proceeded with the operation.

When the removal was completed, the detached bone was fixed in place and the soft issues and skin were sutured over the bone.

Keith Olmstead's recovery was complete. He was out of the hospital in about two weeks.

Some neurosurgeons frequently use a diathermy knife in brain surgery. The "knife" was introduced into neurosurgery in 1920 by the famous Dr. Harvey Cushing. It is electrically operated and cuts by burning. Not only is it used for cutting tissues, but it can also coagulate blood to prevent hemorrhage.

Although brain surgery probably is usually associated with brain tumors to most of us, there are other types of brain surgery that are important.

Injuries often necessitate the skilled services of the neuro-surgeon, primarily in treatment of open wounds, removal of bone fragments which may be driven upon or into the brain, and sometimes to a treatment of intracranial hemorrhage.

Occasionally epilepsy may be helped by brain surgery in cases where the affliction may be caused by the presence in the brain of the specific condition such as a tumor, abscess, scar, or depressed fracture.

Brain surgery is used for some mental conditions (psycho-surgery) and for pain. Probably most commonly known to the public is the prefrontal lobotomy. Dr. Egas Moniz of Lisbon, Portugal began to use this particular psychosurgery in 1936. For many years it held a place of importance in treating "last resort" conditions, but more recently has fallen into considerable disuse as new and more dramatic psycho-surgery is developed.

In the prefrontal lobotomy the familiar technique is to drill two small holes in the forehead. A slender rod that terminates in a small knife is inserted through the holes into the frontal lobe area which is commonly called "the seat of appre­hension."

Carefully the surgeon cuts connecting brain fibers to dis­connect the frontal lobe area from the rest of the brain.

As a result of the operation, patients have a complete per­sonality change, marked by a lack of apprehension and in­difference to former fears.

Results of the prefrontal lobotomy may be appraised by studying the words of Norman Cameron, M.D., Ph.D. and Ann Margaret in their exhaustive study Behavior Pathology (Houghton-Mifflin Co., 1951): "Immediately after surgery, the patient is disoriented and either restless or apathetic. He usually shows loss of sphincter control, which is usually tran­sient but becomes persistent. He may develop an enormous appetite and gain markedly in weight. Not infrequently he has convulsive attacks, which may or may not recur."

The authors go on to observe that as immediate effects of the operation begin to wane, other characteristics seem to manifest themselves as indirect results of the surgery.

"He may be tactless and outspoken, careless of his personal appearance, sarcastic, vulgar and profane," they observe. The patient probably will be somewhat cheerful, although some patients display extreme swings from depression to elation. "He lacks spontaneity, rarely initiates activity independently, and appears inattentive and unresponsive. In extreme in­stances, the patient lapses into an almost vegetative existence."

In summing up their observations, two statements may be significant: "If the aim is to make the patient quieter and more tractable, prefrontal lobotomy appears to be an advan­tageous procedure. . . If the aim of therapy is the social rehabilitation of the patient, however, the advantages of pre­frontal lobotomy are questionable."

As has been stated, the operation is being performed much less frequently as new techniques develop.

Other uses of brain surgery are in the experimental stage. Some hope is expressed that such surgery may bring a meas­ure of relief to sufferers of Parkinsonism, or shaking palsy as it is more commonly known.

With improvements in anesthesia and surgical techniques, the efficacy and safety of brain surgery continue to increase yearly.

To leave the subject of brain surgery and to look at mental health is a natural step. Even the primitives, with their belief in the evil spirits that might be in the head, apparently recog­nized an affinity between the brain and illness; the brain and health.

Today the subject of mental health is freely discussed, better understood, and certainly out from under the clouds of secrecy, fallacy, and frequent inhumanity that have marked it over the centuries.

Through the ages, the idea that the mentally ill person was bewitched by evil spirits, or was a form of the devil himself, or—-in apposition—endowed with godliness deserving of reverence, have periodically held sway in one era or another, from one race and country to another.

The history of the mentally disordered is probably as old as the history of man. It cannot be dealt with fully in a short discourse.

Up until comparatively modern times not a great deal could be done to help the mentally ill. Insanity was not recog­nized as a medical problem. Our history seems to be more involved in how the various civilizations disposed of the mentally ill from one era to another, rather than in treatment for their comfort and possible improvement.

Here the contrasts are wide and extreme. In medieval times, for instance, the care of the insane in Arabia was extremely humane. The mentally ill were kept in asylums where music and stories were told to quiet them. In Europe, at this same time, the insane were chained in madhouses, poorly sheltered, poorly fed, barely clothed, and allowed to die of neglect.

In 1547 an insane asylum was opened in London at the hospital of St. Mary of Bethlehem. Within a short time the name became abbreviated to "Bedlam."

In the 18th century it was considered a fine Sunday after­noon's entertainment to visit London's Bedlam and there, for an admission price, watch the antics of the insane. It was also the custom at other institutions, during this era, to cage the insane and exhibit them for a small fee for the amusement of the public.

Early in the 19th century the treatment was little better. Inmates of the Lunatics Tower of Vienna were put on public display in the same manner as animals in a zoo.

Brutality marked most of the treatment of the ill in these institutions. They were flogged, beaten, bled, dosed with purges, and chained.

In 1791, during the French Revolution, a French physician, Philippe Pinel, was appointed head of the Asylum de Bicetre. For years, previously to the Revolution, he had been super­intendent of the public hospital for the insane at the Salpetri-ere. There he had vainly endeavored to bring humane treat­ment and what measure of science that was available to the aid of the insane. The older doctors of the nation had wielded their authority against him.

Now, as he took charge of the Asylum de Bicetre, he made his inspection trip. He saw the patients chained to posts. He recognized the familiar stench of neglect, the agonies of mal­treatment, and the terror of violence that was used upon the inmates.

At his insistence the inmates were unchained. "They are not vicious beasts," Pinel is reported to have said as he argued his case before the heads of the Revolution. "They are sick people. You'd be just as bad if you were chained up. They have nothing to live for. They're getting no treatment for their mental condition. I know that these mental cases are curable and, if we would give them treatment, we would soon see a change."

His request was granted and all over Europe the tide began to turn toward Pinel's benign treatment of insanity. With the passing of years the "insane asylums" gradually improved, but it actually was not until recent years that a truly modern treatment in such hospitals became common.

Folk medicine has had little, if anything, of a substantial nature to offer in treatment of the mentally ill.

For instance, we might recreate a scene among some early inhabitants of Cornwall in England.

William Hocking, middle-aged, short, broad, and strong, lately had been observed to be acting very queerly.

"A disordered mind," said Tom Penny. "Thou mark me well, 'e is mad!"

Others in the village agreed with Tom Penny. It was also agreed that William Hocking should be treated for his madness.

Volunteers carried water from St. Nun's well at the village to a square pool that was sometimes used for this purpose. When it was filled, Tom Penny selected six of the village's strongest men to assist with the treatment.

When all was ready, Penny sought out William Hocking at his home. Hocking's wife, Eizabeth, knowing of the help that was being brought, wept silently in prayer and hope. Certainly living with a husband suddenly deranged was not to be de­sired. If only the treatment would work!

"William 'Ocking," said Tom Penny. "Thou come with me."

Hocking appeared not to understand and when Tom Penny put a hand upon Hocking's shoulder, the mentally ill man struck it off angrily.

After considerable cajoling Hocking agreed to go with Tom Penny, who took him to the pool where the six stout men .and an assemblage of townspeople waited.

Talking softly and gently, Tom Penny managed to detain Hocking on the edge of the pool, his back to the water.

Suddenly Tom Penny struck Hocking on the chest. Hock­ing fell back into the water with a great splash. Immediately the six strong men jumped into the water and seized the ill man.

Time after time they tossed him into the air and doused him in the water until his struggling ceased, his screams of rage died, and he had become a weak and helpless man.

In all probability the "cure" was very temporary.

In the 12th century a Franciscan monk named Bartholo-meus' Anglicus, who served as a professor in France and England, wrote a book about mental illnesses, one of a number of books to his credit. For many years his books were used as references. Consequently his therapy for "melan­cholia" patients probably was frequently put into use:

"The diet shall be full scarce as crumbs of bread, oft washed in vinegar, and that he be well controlled or be bound in a dark place. He should not see many people nor should he be shown pictures for they will probably make his state worse. All those about him should be required to be still and silent, and they must not answer his nice (foolish) words. In the beginning he should be bled in the vein of the forehead and bled as much as the full of an eggshell. . . The most important thing is to secure sleep for him and for this oint­ment and balming applied to the head may be affected."

Psychiatry and medical psychology as we know it today got a rather slow start after Pinel unchained the inmates at the Bicetre hospital. Daniel Hack Tuke, Sir Thomas Smith Clouston, and Emil Kraepelin were early psychiatrists, but one of the greatest forces to bring about more intensive study in the area came with Sigmund Freud (1856-1939). Freud revolutionized the entire field of psychopathology.

OUR MENTAL HEALTH TODAY—About 17 million per­sons in this nation suffer from mental illness or disturbance. About one million patients are treated each year in public and private mental hospitals. The cost of caring for these patients is more than a million dollars a year.

How does this mental unhealthiness manifest itself? For one thing, it is an important factor in our criminal picture.

Our serious crimes now are in the neighborhood of 2 million each year. About 60,000 or more persons are drug addicts. Our juvenile problem becomes constantly worse. Al­coholism has become a national problem. Each year there are approximately 20,000 suicides and even more attempts.

We are woefully lacking in hospitals to care for the men­tally ill. Of some 200,000 doctors in the nation, only a little more than 10,000 are psychiatrists and more than half of them are connected with institutions that receive the major part of their time.

Some 5,000 psychiatrists who have private practices are no match for the millions who need help. Despite the need for more psychiatrists, not enough doctors are specializing in psychiatry to fill the need. The main reasons, perhaps, are the long years of expensive additional training necessary; the ob­vious fact that many physicians are not temperamentally suited for the work; and the fact that other specialties may be more remunerative.

At present the nation's most important effort in psychiatric research and care probably is centered in the federal govern­ment.

The Veterans Administration has the largest co-ordinated psychiatric hospital program, with 40 mental hospitals. Our largest psychiatric research program is centered in the United States Public Health Service's National Institute of Mental Health at Bethesda. Last year it was slated to have $68 mil­lion to be used for research grants to universities and groups outside the institute, as well as for the government's own program in the field.

All of this may, surprisingly, be of considerable interest to most of our population. Americans are unusually familiar with some phases of psychiatry, or at least some of the phrases, terminology, and theories, since they have been heav­ily exploited by the communications media.

Freud's theories were interesting to Americans. After him came other theories—Adler's and Jung's, for instance. People began to talk about "compulsions" or "frustrations" or "anxieties." The word "neurosis" became common. Psycho­analysis became fashionable. Mothers wondered if their chil­dren would "adjust to environment" properly. Dreams sud­denly became significant.

While a great deal of this onslaught of psychiatry was not fully digested by a great many persons who talked about it, much good came from the interest. People became aware of mental illness—that it is an illness.

Perhaps some of this interest also is explained by the keen observation made by Walter Bromberg, M.D. in the preface to his book The Mind of Man, published in 1937.

"Psychology, the most human of sciences, has always been an intriguing subject. The man on the street as well as the sage is entranced by its possibilities and its accomplishments. Because psychology reaches deep into our lives, it has an appeal that transcends the more objective sciences," Brom­berg observed.

With the impetus offered by public interest as one of its supports, and with research and clinical programs gathering momentum, mental health is rapidly assuming increased importance.

Dr. William C. Menninger of the famous Menninger Clinic in Topeka, Kansas recently stated: "Psychiatry came out of the dark caves about twenty years ago. It moved into the fields of general hospitals, community civic groups, social welfare agencies, juvenile courts, prisons, institutions for the feeble-minded and schools. We began to investigate what all people—not just what one patient at a time—think and feel. Before we knew it, everyone wanted to know about psychi­atry; they were looking to us for practical help, for personnel, for knowledge. We had the green light; it was up to the psychiatrist to go through."

With the growing, widespread interest in mental health, psychology, and psychiatry, there also has been a measure of confusion about mental illnesses and the terminology used in discussion of them.

As a matter of fact, the question is frequently asked: "What is mental illness?"

Any illness implies that something is wrong with a person's bodily functions. We all know and recognize quite a number of indications of illness—a headache, an abdominal pain, soreness in a joint, fever, rapid pulse, high blood pressure, and many other symptoms

Mental illness usually is indicated by an abnormality in behavior—in the manner in which a person thinks, acts, or feels. A person's behavior may be irrational, and that indi­cates mental illness. A person's behavior may be unrealistic and not in keeping with actuality, and that also indicates mental illness or disturbance of some kind.

Obviously there are times when all of us may be irrational in a flare of temper, or unrealistic under emotional stress of the moment, or our behavior may be temporarily influenced by too much to drink, or. when we are too tired. We need not construe these indications to mean that we are truly mentally ill.

But when one—or several—of the indications persists, then mental illness certainly may be suspected.

Generally, mental illnesses are divided into two major classifications: the psychoses and the neuroses. A variation in classification may be found in which a third group is included and called the personality disorders.

The Psychoses are also called the "insanities" and may be acute or chronic illnesses. Ideally, they require intensive hos­pital treatment for several months. Follow-up care is fre­quently required after a patient has left a hospital. Relapses may occur and the patient may have to be hospitalized again.

These are the severe disturbances, characterized by drastic mood manifestations; serious changes in thought, feeling, or behavior; withdrawing from reality; or by persistent halluci­nations and delusions. Among the most common psychoses are schizophrenia, manic-depressive psychosis, involutional psychosis, paranoia.

In some cases the condition may continue for months and into years. Some patients may have periods when they appear to be normal. Some may get along quite well on jobs, in family life, and merely give the impression of being "odd" or "different."

The definitions of psychiatry frequently may be confusing. Possibly some of this confusion arises from the interweaving and overlapping of symptoms, and efforts to place the illness into categories.

Dr. Karl Menninger has expressed an increasing dissatisfac­tion with the so-called "diagnostic categories of mental health" in reference to terms such as schizophrenia, manic-depres­sive psychosis, melancholia, and paranoia, reports Marguerite Clark in Medicine Today. Says Dr. Menninger, "A few of us suspect that there is essentially only one kind of mental illness —the unsuccessful effort to maintain some measure of emo­tional equilibrium in the face of internal and external stress. Symptoms may vary, but all are reflective of the same process."

Dr. I. J. Rossman and Doris R. Schwartz, R.N., in their book on home nursing and medical care, make several perti­nent remarks in relation to the varieties of psychosis:

"No psychotic individual is exactly like any other, even in the areas in which both are manifestly ill," they observe.

They also point out that psychoses are classified by type, "but to say that a person is a psychotic of a particular kind is not to describe his whole personality. It says merely that he has an illness of a specific type. Furthermore, you must also remember that every classification covers a range from the mildest to the most severe forms of a disorder. . . Just as the term rheumatic heart disease covers everything from a slight valvular leak to a severe and incapacitating condition, so schizophrenia may be applied to someone who is still able to function in society and to another person who is totally out of contact with reality."

Schizophrenia (formerly known as dementia praecox) is generally defined as meaning "split mind" or "shattered mind." Claiming more victims than any other psychosis, it is frequently called the "psychosis of youth" because it gener­ally appears in youth and early adult life. It is estimated that about one-fourth of patients admitted to mental hospitals each year are victims of schizophrenia.

The disorder usually is defined further in types. There is the catatonic type:

Patient J.B. is 22 years of age. He is good-looking and, ordinarily, would appear to be pleasant and probably well educated and cultured.

As we look at him, he does not appear to know that we are there. He is completely withdrawn from everything and everyone. He will not talk. He will not eat. Sometimes, as at the moment, he has remained motionless and rigid for more than an hour. He can remain so for hours at a time.

He is almost the antithesis of A.R., another young man, slightly older, who paces wildly and aimlessly. He cannot remain still. He appears to be in a state of agitation and he speaks the same phrases over and over.

"Catatonic, too," explains a therapist.

"But the other patient. . . ?"

"I know. It may be confusing to you. As we define the catatonic type here we observe that the condition is charac­terized by peculiar conduct, phases of excitement, as you see him in now—or phases of stupor. There's negativism. Im­pulsive behavior. Usually, hallucinations. Withdrawal."

"Will J.B.—the first one we saw—remain as he is? With­drawn, quiet?"

"Not necessarily. He could suddenly become excited and agitated as A.R. is."

"There are other types?"

The therapist nods. "The simple type—and known as that —may sit quietly for hours, paying no attention to anyone or anything, yet he keeps a limited contact with his surroundings. There is a defective interest. Gradually an apathy develops."

The therapist nods in the direction of a pleasant-looking young woman who appears to be quietly staring into space.

"Mary, over there, is an example. Her husband—a fine young man—still hopes that something can be done."

"What's the usual history?"

"In the past, usually, it has been a progressively worse sort of thing. Leading her to meals. Probably feeding her. Dressing her. Although I dislike the phrase—eventually she may be­come a 'human vegetable' with no feelings, thoughts, desires, or emotions."

He turned toward a man sitting by himself across the grassy, summer-warm yard of the mental hospital.

"That's John. At one time he was a successful young businessman. He's a good example of the paranoid type."

"In what way?"

"He hears voices which tell him to do things. He also has an idea that there is a complicated plot to kill him and that most of us are secret agents detailed to that mission by some mysterious power bent on eliminating him. These are the so-called delusions of persecution."

"But isn't there a chance of his becoming violent?"

The therapist shook his head. "I doubt it very much with him, although there are instances when a paranoid type may be hostile and violent. Actually, though, instances of violence are rare and not many schizophrenic patients are dangerous."

"Are there still other types of schizophrenia?"

"One more. The hebephrenic. He usually does silly, child­ish things. He smiles and laughs inappropriately. Sometimes he coins words and phrases and his talk usually is nonsense. He isn't very careful about his appearance or personal cleanliness."

"Those are the four types?"

"As we recognize them here, although I haven't mentioned all the symptoms that we find in some of the cases."

Thus we quickly get glimpses of schizophrenic patients.

What may lead to the condition?

Cameron and Margaret explain that "The socially imma­ture person who develops a schizophrenic disorder—usually an anxious solitary person, also—has entered adolescence or adulthood inadequately socialized. He lacks the degree of role-taking skill necessary for ease in shifting perspective un­der stress. He has learned to rely heavily on fantasy; but he has not mastered the techniques of social validation, of shar­ing his interpretations and conclusions, and in modifying them in accordance with the attitude of others. When, through attempted social interaction or private preoccupation he en­counters severe conflict, thwarting or delay, and develops marked anxiety, he is almost sure to show disorganization."

This, in turn, amplifies their stated definition of schizo­phrenic disorders as "syndromes of disorganization and de-socialization, in which delusion and hallucination are promi­nent, and in which behavior is dominated or determined by private fantasy."

Turning from the "psychosis of youth" let's look at another psychosis, more common to persons around 50 to 55.

Involutional psychosis—or involutional melancholia— oc­curs during the years that frequently are called the "turning back period."

George S. is an example.

Now in his early fifties, George had worked 30 years for the same firm. He and his wife, Mildred, had reared two children, a boy and a girl, who had married and established their own homes. George had three grandchildren.

His salary was quite adequate for the couple. They owned their home. They had a fairly substantial savings account. There would be company retirement payments as well as Social Security for the retirement years. On the surface it would appear that George S. had little to worry about.

His wife, Mildred, told their family doctor what the actual situation was.

"He worries constantly, Doctor. At night he gets up and paces. I know that he doesn't sleep enough. He's tired in the morning. He doesn't eat well."

"But what is he worrying about, Mildred? You two know me well enough so that you can be frank. What's wrong?"

"That's just it! I can't understand why he worries. We have plenty of money for our needs. The children are fine. I'm in good health—as you know. Everything is fine at the office. He just received another raise and promotion."

"But what, Mildred? There must be something."

"It's his—well, attitude. He seems to think that he's a failure. That none of us really care for him. He thinks his whole life has been wasted. He hasn't lived it right. He hasn't been a good father or husband. And he worries about his health. He has pains. He thinks he has illnesses. But he doesn't come to you. He acts as if no one cares and . . . oh, I don't know what to think!"

"I do, Mildred. We'll have to work this out—but I'm going to suggest a psychiatrist."

"I've wondered—"

"Tell me—he doesn't have spells when he's terrifically 'high' to offset these 'blues'?"

"No. Why?"

"That might indicate a little manic-depressive trouble. It sometimes hits at this age. This looks more like involutional psychosis."

"Can a psychiatrist help?"

"I think so, Mildred. Let's find out."

In this case the psychiatrist used drug therapy to good advantage. Harry Milt in Basic Facts About Mental Illness reports that about 7 of every 10 persons treated for inyolu-tional psychosis improve considerably or recover entirely. Usually only a few weeks or months of treatment will bring a change.

How are psychotics treated for their illnesses? The methods vary. Improvements have been steady, especially over the last generation or so.

For a time shock therapy was in the limelight. The theory behind shock therapy is to do something to the patient's nervous system which will bring him out of withdrawal, de­pression, or excitement.

Insulin was a popular means of producing shock for a time, but has given way to the more commonly used electro-shock which sends a light electric current through the pa­tient's brain for a split second to induce a convulsion.

The patient loses consciousness, has no awareness of what is happening, and is said to experience no pain. After a short time he regains consciousness, remaining in a rather confused state for a time.

Combined with psychotherapy, shock therapy has been a treatment for schizophrenia, manic-depressive psychosis, in-volutional psychosis, and severe neurotic depressions.

The newer drug therapy techniques have played a large part in doing away with shock treatment in many instances, and shock therapy is frowned upon by many doctors except as a last-resort treatment.

Individual psychotherapy is a technique designed to relieve symptoms and to help a patient achieve a less fearful, more contented outlook upon life, and to achieve more effective methods for him to handle life's problems.

The patient tells a therapist his thoughts, experiences, emo­tions and feelings about things. The therapist helps him un­derstand and to get an insight into the problems that have caused the patient his troubles. The therapist encourages him to release bottled up emotions. There is a face-to-face dis­cussion atmosphere in the sessions. It also is called supportive therapy because the therapist actually works with the patient's conscious mental faculties by direct discussion and influence.

This may be differentiated from the Freudian psychoanal­ysis which is an attempt to delve much more deeply into the life and background of the patient—into the hidden depths of the unconscious.

Milt says of psychoanalysis that "the method is based on the theory that the manifestations of mental illnesses are the result of deeply buried emotional conflicts originating in childhood".

Consequently the psychoanalyst attempts to bring the conflicts from the unconscious mind—where they have been hidden and repressed—out into the patient's conscious aware­ness. Then they can be "relived" and resolved.

In practice, psychoanalysis is a study of emotions through free association and dream investigation. By "free associa­tion" is meant a technique in which the patient talks freely about anything that comes to his mind. It is thought that being "off-guard" may result in repressed and hidden ideas coming to light more easily.

Dreams are used in somewhat the same method, the patient and the psychoanalyst endeavoring to interpret the dreams and find out what repressed ideas or emotions might be dis­covered and dealt with.

Psychoanalysis is used, primarily, with the neurosis, and sometimes with the psychosis, if the patient has enough con­tact with reality to communicate with the doctor.

Psychoanalysis may be a long-term treatment, sometimes requiring several hours a week for several years. Other cases may require only a couple of hours a week over a year or so.

Group therapy has been finding more and more favor for both neurotic and psychotic patients.

Several patients engage at one time in group therapy. A therapist is present and patients are encouraged to discuss their problems freely; to explain and air their anxieties, fears, and hostilities.

Patients gain support from one another. They learn that they may share the same feelings, frustrations, emotions, and problems. Opinions are voiced. Suggestions are made and situations analyzed.

It might be noted that unlike psychotherapy with a thera­pist, the patient in group therapy can formulate his own reactions and share them in social communication with others. He can learn of the commonness of his anxieties, for instance, and the extent of his own deviation from others. There is a definite element of social learning—or relearning—in group therapy that is good.

The Neuroses—or psychoneuroses as they are frequently called—are less severe emotional disturbances and comprise the largest group of mental illnesses. In many cases they can be treated in offices or clinics. Some are more disabling than others. Some may prevent persons from working. Some may interfere with normal activities only during periods of crisis.

The most common symptom of neurosis is an exaggerated and misplaced anxiety.

"I can't explain it exactly," Mrs. Valdez told a psychiatrist in a large clinic. Her pretty, young face reflected her distrac­tion. "I have a terrible dread that something is going to happen. Every time the telephone rings I just know it's going to be someone to tell me that my husband has been killed, or my mother has died, or something dreadful has happened somewhere else. I'm getting so I don't want to even answer the telephone or go to the door or see anyone come near the house. It may be bad news. Someone to tell me something terrible."

In another office down the hallway of the clinic a tall, good-looking young man with the shoulders of an athlete nervously smoked a cigarette as he talked with a doctor.

"It's getting me down," he said, almost angrily. "I've got a good job as a salesman—a good future with the firm. But this damned claustrophobia is ruining my life. Every time I get in an elevator I get it so that I can't think straight when I finally get off and go into a customer's office. I even have to leave all my car windows open when it rains. If I shut them, it hits me. I'm afraid to get in an airliner—drive through a tunnel . . ."

Down the street a new building was being erected. A young workman on his first job stood on a scaffold, desperately clutching an upright timber, his eyes closed tight, sweat bead­ing his forehead.

An older workman walked across a plank, three floors above the sidewalk, and spoke quietly to the younger man. "Take it easy, son. Just hang on and take it easy."

"Get me down," the young man whimpered. "For God's sake, get me down. I can't stand it up here. So high. Please help me get down!"

These three examples demonstrate evidences of neuroses. Mrs. Valdez's anxiety is a specific symptom. The young salesman's self-recognized claustrophobia is another, as is the fear of height—acrophobia—with the young workman. The latter two, are phobias—exaggerated or unreasonable fears about some specific thing or situation. In such case a psy­chiatrist probably can help. Recognizing an anxiety or fear and facing it, fighting it, is a major step toward relief.

Fundamentally, psychiatrists tell us, the neurotic person is insecure, fearful, and defensive. He has no faith in himself, nor in others. He feels basically inferior, inadequate, helpless. He believes others to be unkind, inconsiderate, unloving, even cruel. They seek to take advantage of him or to hurt him. He must constantly be on guard against them.

Consequently, his pattern of life may be one of escape and withdrawal. He may be shy, unsociable, introverted. He may seek to escape responsibilities, to avoid changes, hesitate to marry and have a family.

On the other hand, he may be ready to fight at the drop of a hat, to be touchy, ready to quarrel or argue at any pretext. He is easily insulted. He may become antisocial and turn to delinquency or crime as a method of revenging himself against his "enemy."

A commentary on mental illness from the U. S. Department of Health, Education, and Welfare explains the third classifica­tion:

"Personality Disorders are another category of emotional disturbance. These are difficulties in adjustment that manifest themselves in disturbed behavior, such as seen in the drug addict, the chronic alcoholic, and the delinquent. In still other cases, difficulties in handling problems and in working out a satisfactory adaptation result in psychosomatic disorders. Here, symptoms of emotional disturbances are expressed through physical illnesses. Hypertension, peptic ulcers, and ulcerative colitis are frequently associated with this type of disorder."

Also under the classification of "personality disorders," psychiatrists frequently refer to the psychopathic personality, which is recognized as a major mental illness that differs from psychoses and neuroses.

Among the persons suffering from this type of illness may be found professional killers, hoodlums, gangsters, embezzlers, confidence men, and others of this type.

The person with a psychopathic personality may appear to be quite normal in many ways, but he usually is without decency, justice, conscience, responsibility, or any feeling of humanity. He is usually antisocial, immoral, and frequently a criminal.

It has been said of him: "The person with a severely psycho­pathic personality knows that there is a difference between right and wrong—but he does not care." Recently such a person has been labeled "sociopath" because his problem is "getting along in society."

In discussing mental illnesses, it should be remembered that although there may be specific symptoms for the various ill­nesses, almost always there is an overlapping of symptoms. There is no clear, sharp line separating one from the others.

Nor are the causes of mental illnesses usually certain and apparent. Some kinds may result from brain damage, infec­tions, or old age, but these are in the minority. No change in brain structure is detectable in most cases.

The illnesses may be the result of organic changes, or pro­longed and severe strain and stress, or a combination of both. Most scientists think that a variety of factors may cause mental illnesses. Environment may be a factor, physiological conditions may contribute, experiences—especially during early years—may be responsible. As yet no completely satis­factory answer or explanation has been found.

Whatever the causes, and whatever the results, few of us can hope to escape personal contact with some person who is mentally ill, or to avoid knowing the sordid details of the results of mental illness, or to be affected in one way or another by mental illness in others. For some the contacts are tragic.

On a secluded country road, a young couple parked after a dance. The man, Mel Easterman, was 22 years old, a garage mechanic, and well liked in the community. The girl with him, 20-year-old Marianne Findley, was exceedingly pretty, with dark brown hair and snapping brown eyes. They planned to be married within months, and they frequently stopped on this "lovers' lane" before going home after a date.

Marianne was in Mel's arms and they were lost to their surroundings in their lovers' kiss. They were not aware that anyone was near them until the door behind Mel was wrenched open and a strong arm circled Mel's neck and he was pulled back out of the car and thrown to the ground.

Marianne screamed as she saw a tall, hulking man kick her fiancée repeatedly in the face until Mel was a quiet form in the darkness.

Too frightened to move, the girl watched with wide eyes as the man turned toward the car, came around and opened the car door beside her.

She screamed again and fought desperately when his hands closed over her arms. The man struck her in the face repeat­edly.

"Stop yellin' . . . stop yellin' . . . stop it!" he com­manded.

She stopped fighting, dazed by his blows, exhausted from the struggle and the desperate fright that swept over her as the man half carried, half dragged her away from the road into the darkness of heavy brush and trees.

She found strength to fight again, briefly, as she felt her clothing being torn from her. Then the man's merciless weight bore her to the ground and she felt the ruthless pain and tearing of his sexual attack.

An hour later she stumbled to the door of a farmhouse and managed to ring the doorbell. A sleepy-eyed farmer gasped as he saw her crumpled on the doorstep. He called his wife and they took her into the house.

Shortly afterwards, hastily summoned police found Mel Easterman dead beside his car. Marianne was taken to a hospital. And somewhere in the night a man—obviously mentally ill—fled from a type of crime that all too often sickens an apprehensive public.

The next night dozens of parents warned their daughters about parking on lonely roads with their boy friends. Police increased their vigilance. Thus the impact of a crime born of mental illness was felt by the whole community.

Or let us look at another case that also made an impact upon others, but in a different manner, and from a different kind of illness.

Mark Quarrie was 45, married, the father of three children, and branch manager of a national advertising firm.

His wife, Laurie, still slim and smartly pretty, had been worried about Mark for months. The pressure at the agency had been unusual. Two of the largest accounts had changed to other agencies. Several advertising campaigns had gone wrong. Mark was having trouble with an account executive, Simon Borse. A woman copywriter, Mildred Ustace—who was important on a fashion account—was, as Mark put it, "giving me a bad time." They could not agree on copy or policy.

Normally, Laurie would not have worried too much about the situation. It was to be expected in advertising, and there had been a time—when Mark was younger—when he would have taken it in his stride. Now he needed what he thought was a crutch to help him take it. The highball before dinner had become two or three, and several after dinner. Sometimes in the late afternoon when she called him, his voice was slurred a little. Mark didn't drink as well as he once had.

Now, on this late autumn afternoon, Mark had just called with more bad news. The advertising manager at the "fashion house" was demanding that Mark turn the account over to Simon Borse. The firm manufactured women's clothing and the advertising manager had said, "I feel that you don't have the touch for it, Mark. You understand—nothing personal. It's just that maybe—well, someone younger. Like Simon. And Mildred says she works well with him."

"I don't know," Mark had answered, sparring for time. "I want you to be happy, of course. And the main thing is to do a topflight advertising job for you. That's why we are in busi­ness. Only—well, Simon is still young in the business."

"Look, Mark," the executive had said quietly. "Let's put it another way. Either we get Simon, or I'll call New York and ask the head of your firm why I can't have him."

Mark had managed to contain his quick anger at the effrontery of the man. The customer was always right. Even the tough, hard little man who ran the advertising for this manufacturing business. It was a cold, ruthless, hard business.

"Let me think it over," Mark had said.

The advertising manager had smiled knowingly. He had recognized that Mark would want to save face. "Sure, Mark. Let me know in the morning. And look—don't take it per­sonally. You're tops in some other lines. Industrials, for instance. But not in this business. Let us-have Simon—Simon and Mildred."

An hour later, as Mark told his wife what had happened, she detected the slur in his voice.

"Mark, why don't you come home and forget it? It isn't worth getting upset about. Come on home, and we'll go out tonight."

"Oh, I'm all right, hon," he assured her. "I just wanted you to know what kind of double-crossers I've been nursing here. Simon and Mildred. Simon probably wants my job."

"Don't be silly, Mark. You know how you stand in New York. You're one of their best men. You're branch manager here. Isn't that proof?"

"Right! Only they're sort of tough back there when it comes to losing accounts."

"Oh, Mark—stop it! You're worrying needlessly. Why don't you assign Simon to the account temporarily? He'll wear out his welcome. They need your experience and creativity."

"But they like Simon and Mildred," he said, laughing with­out humor. "Don't worry, though. It's okay. Just thought I'd let you know."

"Mark . . . ?"

"Yes?"

"No more drinks. Right?"

"Don't worry, Laurie. I'm okay. See you for dinner."

Mark put down the telephone and stared at it for a moment, visualizing his lovely wife, the children and the house. He still owed thirty thousand on the house, and a thousand on the car he'd bought for Laurie, and the loan at the bank. There were the monthly bills that ran so high, the three thousand he'd borrowed from his brother. He'd damned well better not lose his job! Not the way things were. Not with less than a thousand in his checking account.

Almost automatically he got up and left his office, neglect­ing to tell his secretary where he was going.

A small, dark bartender at the cocktail lounge flashed a welcoming grin. "As usual, Mr. Quarrie?"

"Scotch—as usual," Mark answered, still with that humor­less smile. He sat at the bar and quickly downed the drink, waiting for its warm glow to flow through him, and for the pickup he knew was coming. Once the pickup warmed him, when the liquor was getting to him, his troubles would be less onerous. That was the good part about liquor. It took the sting out of trouble. He ordered another.

An hour later, the bartender looked concerned as Mark, now visibly affected by all the drinks he'd had, ordered again.

"Look, Mr. Quarrie, maybe you've overlooked the time. It's almost five and you've probably got some letters to sign."

" 'S all, ri', Mike ... not drunk. Not 't all." Mark made an effort to make the words come clear and precise. He had better get out of here. He'd had enough. "Thanks, Mike. Yeah . . . thanks."

He returned unsteadily to his office. He sank heavily into his chair and scowled at his desk. The events of the afternoon came back to him in the new perspective colored by alcohol. Suddenly he felt strong and certain and very angry. He dialed a telephone number and after a moment his call was put through to the fashion house advertising manager.

"Yes, Mark? What is it?" The advertising manager sounded a little impatient, as if it was time to go home and he didn't want another business call. "Made up your mind about giving us Simon?"

"You," said Mark, "can go straight to hell! You and your company. We resign the account."

There was a silence at the other end of the line and then the ice-cold voice of the advertising manager.

"That's just fine with us, Quarrie. I'll send you a letter in the morning to confirm it—and one to New York. If I don't call right now." The telephone clicked and the line went dead.

Mark snorted and dropped the telephone in its cradle. He wished he had another drink. He got up and walked uncer­tainly to his office door and went out. His secretary looked at him and smiled nervously.

"Is there something, Mr. Quarrie—?"

"Nope. Everything under control, Alice. Gonna see Mildred."

"I'm right here, Mark," Mildred Ustace said, coming out from her office as she put on her gloves to leave. "Something?"

"Yes. You're fired. I won't have a floozie like you working in my shop."

Simon Borse came out of his office at the sound of Mark's raised voice.

"Take it easy, Mark," he admonished. "You've been drink­ing."

"Sure, I have. I think I'll take a poke at you, Simon. I don't like men double-crossing me behind my back."

"You're drunk. Take it easy."

"Okay. Okay! I'll take it easy. Fire you easy, like I did Mildred. Just resigned the fashion account, too. Got every­thing under control . . ."

He turned and staggered a little as he started back for his office. His staff stared after him in astonishment and concern.

"If he did, Mildred," Simon said softly. "If he resigned the account—that means the end for him with the agency. He's been hitting it up—and they know it. And if he did that, it's curtains."

The following morning, at home, sick with a hangover and remorse, and miserable in his despondency, he talked long distance with the president of the agency.

"Mark, I'm sorry," the voice in New York said. "You know how I feel about you. But it isn't up to me. After all, it's a business, Mark. When he called me he said you sounded drank when you resigned the account. If you can give me any good reason, Mark—"

"I can't," Mark said quietly. "It's no good. I wish I could. But I just can't."

"This drinking. You never hit it like this, Mark. What's wrong?"

"I don't know. Pressure, I guess—only I never could buy that excuse from anyone else."

"Is Laurie there?"

"Yes."

"Let me talk with her."

Silently Mark handed his wife the instrument. She talked for some time with the agency president and when she broke the connection there were tears in her eyes.

"You're not fired," she said softly. "He's pretty wonderful, Mark. You're on sick leave for a while, and we're going to have a chance to get you off that—that Scotch kick of yours."

Mark tried to say something, but couldn't. Finally he man­aged to speak again, knowing that there were tears in his own eyes.

"Look, he doesn't have to put me on sick leave," he said. "I don't want charity. I'll quit and find another job."

"No, Mark. You are sick. He knows it. He's a very smart man. He even had his doctor get a name for us. A Dr. Sident here—"

"But he's a psychiatrist! What—?" He stopped speaking abruptly as he saw the look in his wife's eyes. "Sure," he nodded. "Sure. I guess I am sick. I guess I've been sick for quite a while. I'd better do something about it while I still can. I'll see the doctor."

Mark Quarrie saw Dr. Sident and with psychiatric aid was able to understand how to cope with the strain and pressures of his job without resorting to an alcoholic crutch. He now is back on his job and the branch is prospering better than ever before.

It is significant to know that Mildred is now copy chief of the office, and that Mark was able to get the fashion house back as an account; and that Simon Borse, with the help of Mark's wise guidance, is doing an excellent job as the account executive.

Mark's sole comment about it to a close friend was: "Worrying about nothing almost made an alcoholic, unem­ployed advertising man out of me. Come on down to the corner. I'll buy you some buttermilk."

Alcoholism has become a major problem in the United States. Researchers claim that two out of every three adults over 15 years of age use alcohol in some form. About one sixth of them are regular drinkers, to the extent of drinking at least three times weekly. About one-half are occasional drinkers. Probably 5 million or more are "chronic alcoholics," and one-seventh of that number are women. These are com­pulsive drinkers.

The reasons for alcoholism may be partly explained in a statement made by Dr. Leon A. Greenberg, Associate Direc­tor of the Yale Laboratory of Applied Physiology from which stemmed the university's Center of Alcohol Studies.

Dr. Greenberg has said: "The alcoholic is a victim not only of the bottle, but of his own inadequacy. In his inability to meet problems, he uses alcohol as a personality crutch. Natu­rally, if this sort of person never uses alcohol, he cannot be­come an alcoholic. But if he does not use alcohol, he may seek escape from his problem by turning to drugs, such as cocaine, or morphine, or sleeping pills, or by neurotic be­havior. A person's temperament also plays a large part in his behavior reaction to drinking. A few drinks may make a phlegmatic man normal, a normal person the life of a party, a vivacious person a nuisance."

Few of us can avoid meeting or knowing alcoholics. About 85 per cent of our alcoholics may be found in offices, fac­tories, homes and normal American community life and activities.

Fortunately, since it is now fairly well recognized that alcoholism is a disease, there is hope that much can be done to combat it. Some firms, such as the advertising agency for which Mark Quarrie works, recognize the problem and are trying to do something about it with employees who fall victim to the disease.

The American Medical Association recognizes alcoholism as a treatable disease and has gone on record: "Chronic alcoholism should not be considered as an illness which bars admission to a hospital. The chronic alcoholic in an acute phase can be, and often is, a medical emergency."

Help is available for alcoholics in almost every community. The work of Alcoholics Anonymous is famous. Because of it more than 250,000 former alcoholics now are living normal, productive lives.

Aided by the Yale Alcoholic Center, Connecticut has estab­lished six outpatient clinics and a hospital for alcoholics and the Yale plan has been carried to similar clinics in 22 other states.

All in all, most of the best work being done in the field is to enable an alcoholic to help himself (or herself). In the process of cure, a number of factors may be involved. Psy­chiatry, medicine, religion, Alcoholics Anonymous, and social work may all take a part in treating some aspect of the problem that has driven the alcoholic to drink.

One thing is accepted by most experts: there is no cure for the alcoholic so that he can go back to being a "social" drinker again.

"The cured alcoholic," says Dr. Selden D. Bacon of Yale, "is a person who can't ever touch a drink again. If he does— bang! He'll go back."

NARCOTICS—Suddenly the narcotic picture in the United States has changed. It is more alarming, tragic, and shocking than ever before because it is becoming solidly associated with youth.

When we went into the '50s the average addict was 38. Today the average addict is a young man, about 25, city-bred, and emotionally disturbed. According to the Federal Bureau of Narcotics, about 12 per cent of our more than 60,000 drug addicts are under the age of 21.

Three couples, all high school students, gather in a parked car early in the evening. One of the group, a petite, vivacious girl with red hair, uncertainly takes what looks like a home­made cigarette.

"How do I do it?" she asked. "Just smoke it?"

"Like this," one of the boys explains. He lights one of the cigarettes and draws in the smoke mixed with air in a sucking inhalation.

The girl tries it and coughs a little. She tries again and so is introduced to marijuana.

A small-town newspaper breaks a front page story exposing the sale of "pep" pills to teen-agers. Three youths under 20 are arrested with heroin in their possession. Youth and dope are in the headlines.

The personality problems and mental disturbances leading to and resulting from the use of narcotics are manifold and serious. Cures are difficult; rehabilitation frequently inade­quate.

At present there is a good deal of conflict about how the narcotic problem should be handled. Some authorities believe we need new laws. Some feel that we need new methods of treatment. Some point out that in England addicts are re­habilitated before they are taken off drugs and that the system appears to work.

Meanwhile, the nation has the greatest crime rate of any civilized nation and the largest illegal market in drugs. The Committee on the Judiciary of the U. S. Senate reports that addicts are responsible for about 50 per cent of all the crimes committed in large metropolitan areas, and a quarter of all reported crimes in the nation.

HOMOSEXUALITY—Once firmly hidden from public con­sciousness, it has been only recently that homosexuality has been openly discussed and treated as a psychiatric problem.

The causes of homosexuality are varied and frequently quite complex. The ability of psychiatrists to influence the homosexual condition in a patient is doubtful. Many psy­chiatrists are of the opinion that the most they can do to help a homosexual is to help him understand his (or her) own problem and to make a better adjustment to society.

Some of the problems of homosexuality are discussed in Chapter 18 of this book.

TENSION—Probably the greatest complaint of persons seek­ing psychiatric help was expressed in the words of a business executive to his doctor.

"I'm so damned tense I feel as if I'm ready to snap," he said irritably. "Can't sleep. Can't treat anyone decently. Short-tempered. On edge. Nervous as a cat. Get so tied up in knots that my muscles ache."

"Why?" asked the doctor.

"Why?" The businessman shook his head in despair. "Look at the international situation! Look at our national business picture! The tax situation. Juvenile delinquency. The people you get to work for you. Irresponsible. Self-centered. Disloyal. Not willing to earn their salaries. One-hour coffee breaks. Have you any idea what it means to try to operate a business under conditions like these? And sometimes you wonder if there's any point in it, anyhow. Missiles probably aimed at you from a couple of thousand miles away. Someone gives an order, someone pushes a button, and we've had it. Why shouldn't I be tense?"

Tension has become an important word in American health. Whether or not tension is creating havoc with you probably depends upon how you handle it.

At the pace we live today it's almost impossible for most of us to get through a day's work without engendering some tension and fatigue.

Perhaps the test of whether or not it's hurting you too much, is your state when you've finished the day. If you can get a good night's sleep and awaken refreshed and without tension, you probably are in good health. If you awaken still tense, still on edge and feeling tired, the symptoms may be an indication of an emotional disorder.

People such as the tense businessman can get into addi­tional physical trouble beyond the feeling of tenseness.

When we become tense from disagreeable emotions our muscles become tight. Many of us have a sample of this occasionally with a "back of the neck headache" when we've had a particularly trying experience or day.

That headache probably was brought on by tension. But tight muscles resulting from tension can hit at other places in our body. A muscle spasm can—and frequently does—contract the colon into agonizing pain that may be mistaken for gall-bladder colic, an ulcer, or appendicitis. The muscles at the upper and lower ends of the esophagus can contract and make it difficult to swallow. In some persons tension can cause trouble with the endocrine system. It may cause blood vessels in a heart to contract, and—for instance, in a sudden burst of anger—even cause death.

John A. Schindler, M.D., has this to say about such condi­tions: "It used to be called psychoneurosis. Now it is known as psychosomatic illness. And it is not a disease in which the patient just thinks he is sick. The pain you get is often just as severe as the pain you get with gall-bladder colic."

Schindler goes on to explain that psychosomatic illness is not the result of a bacterium, virus, or new growth. "It is produced," he explains, "by the circumstances of daily living." (See Chapter 22).

What is to be done about mental illness? Where is there help to combat it? How can it be helped? Who treats it?

Psychiatrists treat mental illnesses. To become a psychi­atrist a medical doctor specializes in mental illnesses. He serves as an intern after graduation, and for several years as a resident physician in a mental hospital.

Psychoanalysts are psychiatrists who take additional train­ing and specialize in psychoanalysis. As previously explained, this treatment technique seeks to bring to consciousness the patient's unconscious emotional conflicts in the hope of elimi­nating or lessening them. All psychoanalysts are psychiatrists, but all psychiatrists are not psychoanalysts unless they have taken the extra training to practice this specialty.

Clinical psychologists axe not medical doctors, but they generally hold a Ph.D. degree. A clinical psychologist con­centrates on the clinical aspects of normal and abnormal be­havior in postgraduate studies and then takes special training in a clinic or mental hospital. He administers tests to patients to help the psychiatrist arrive at a diagnosis. Occasionally he may aid in psychotherapy and group therapy.

Psychiatric social workers hold an MSSW degree. Their postgraduate work is concerned with psychiatric problems. They take special training in clinics, mental hospitals, or social work agencies. The main tasks assumed by the psychiatric social worker is to maintain contact between the mental hos­pital patient and the family, to help the family understand the patient's illness, to adjust problems caused by the hospitaliza-tion, and to help supervise the rehabilitation of the patient upon discharge from the hospital.

Help from these professional workers in mental illnesses may be found in mental hospitals, usually state, or Veterans Administration, for those eligible for such help; in psychiatric clinics that usually are community treatment centers for mentally ill patients who do not need hospitalization; and from psychiatrists in private practice.

TREATMENT—In summary, treatment methods include in­dividual psychotherapy, psychoanalysis, group therapy, play therapy, sedation, chemotherapy (drug therapy), shock therapy, and psychosurgery. Over the last few years hyp­notism also has been used more frequently. According to observations made by Robert Coughlan in Life, March 7, 1960, "Hypnosis is of potential value in the treatment of almost any physical illness in which a pronounced emotional element is involved. It can help directly in the treatment of anxieties, compulsions, phobias and other more severe cripplers of the mind."

When psychoanalysis and individual psychotherapy are used, one patient at a time is treated. When group therapy is used, several patients participate with the encouragement of a therapist. It has proved to be an effective treatment in many instances. In the sessions, patients discuss with other patients their anxieties, fears, and hostilities. Each patient benefits through the support and approval given to him by the others, and by knowing that others may experience the same prob­lems that he does.

Shock therapy is falling into disuse and, like psychosurgery, is coming to be considered only as a last resort when no other treatment will help.

Chemotherapy—drugs—have held the center of attention most recently in the drive against mental illnesses. The use of tranquilizers (see Chapter 11) has become almost standard in many conditions. One of the main aids from the drugs is their ability to sometimes bring a patient out of a withdrawn or agitated state so that a psychotherapist can "reach" him in an effort to bring about successful treatment.

Probably the most exciting news about the problem comes from researchers who are finding evidence of biochemical origins of the illnesses. Chemotherapy is very much in evi­dence as we look to possible cures for the mentally ill.

Nobel Prize-winning chemist, Dr. Linus Pauling, of the California Institute of Technology, confirms this new hope. "Mental disease may be due to abnormalities of the molecules, or chemical make-up of the genes, the carriers of heredity," he says. "Such a solution will not come quickly—perhaps within twenty years—but some day, the correction of the deranged molecules which cause mental disorders will be found—not on the psychoanalyst's couch, but in the chemist's laboratory."

Meanwhile, very practical use is being found today in treating mental illnesses with the aid of drugs.

How do the drugs help? What kind of drugs are they?

At a state mental hospital a "violently disturbed" young man, Carl T., is admitted.

His mental disturbance has, in effect, taken him out of contact with the world around him. He displays hostilities. His talk is not rational. He rejects everyone. This is the pic­ture that his relatives and friends have of him, in their words and observations.

His attractive young wife was frightened and sick with worry and grief about Carl's condition when she went to their family doctor.

"I can't reach him," she said. "I can't get through to him. I ... I ... it's terrible!" She wept silently, tears running down her cheeks, her dark, brown eyes filled with grief and fears for her husband; the disheartening frustrations of trying to find the man she had married in this new Carl who was a stranger.

"Manic excitement," the doctor said, half to himself. He asked himself a question as he thought. "Schizophrenia?" He looked at the young wife and nodded in decision. "We'll need a psychiatrist," he said.

At the state hospital the effort is made to calm Carl's agita­tion and "open his mind" to effective treatment, so that the benefits of psychotherapy can be his.

He receives a "tranquilizer." Possibly chlorpromazine— Thorazine—may be used. This is the prototype of a growing number of potent drugs being developed in what are collec­tively called phenothiazine derivatives. Thorazine is used to calm mental patients.

Tranquilizers differ from sedatives. They do not just dull the senses. They can actually make symptoms such as anxiety, agitation, and delusions disappear. They generally leave the patient relaxed. He usually is clear-headed and in a peaceful frame of mind.

Not only are such tranquilizers being used virtually as standard treatment for some types of psychoses in hospitals, but they are prescribed by doctors for nonhospitalized patients who are being treated for neurosis or a temporary emotional disturbance.

Many experts believe the best use of tranquilizers comes through the ability of the drugs to bring a patient out of a withdrawn or agitated state so that he can be reached by a psychotherapist.

Other types of tranquilizers, such as meprobamate—also known as Miltown or Equanil—are milder and serve as muscle relaxants that act upon the nervous system and help to break feedback chains of tensions.

As previously mentioned, in India physicians have treated insanity for 3000 years with roots of the rauwolfia—snake-root—plant. From this root today's chemists developed resperine, the prototype of rauwolfia alkaloids and combina­tions which constitute a class of tranquilizers. The drug was introduced by the Ciba firm as Serpasil. (See Chapter 11.)

Some of the tranquilizers may develop side effects, includ­ing jaundice. Newer drugs called monoamine oxidate in­hibitors, such as Marplan, Nardil or Parnate, apparently give satisfactory results with freedom from jaundice as a side reaction.

Psychic energizers are drugs that have come into important use only during the last three years or so. Roughly speaking, they may be considered—as their name indicates—the oppo­site from tranquilizers.

Iproniazid—Marsalid—is possibly the best-known of the group. Others are nialamid and phenalzine.

An example of the use of iproniazid may be found in the case of a young married woman who became the victim of what she could only describe as a "terrible feeling of depression."

Apparently there was no reason for her depression. She had a marriage that was happy. She had healthy children. Her husband was energetic, successful, and a hard worker who loved her and the children. She was intelligent, well-educated, and extremely lovely.

"Yet the depression was so great that I attempted suicide," she admits. "I swallowed a bottle of aspirin, but fortunately not enough to kill me."

She tried analysis over a period of years, but unfortunately it did not seem to help her.

"I simply couldn't get hold of myself—my thinking, my emotions," she explains. "I avoided talking with people. I wouldn't buy new clothing, and I wouldn't keep myself well groomed. I was just completely disorganized, it seemed."

The answer for her came when a new drug treatment was begun with her. She was given iproniazid and reports that with the first pill she took, even before she arrived home from the doctor's office, she seemed to regain the happy, contented life she had lost.

The new drugs also seem to have the ability to release creative energies and, possibly, to heighten intelligence.

For instance, a young artist who had been in a serious "slump" that had blocked him from producing any canvases for months was given iproniazid. The drug seemed to com­pletely unlock the barrier and he began to produce almost prodigiously.

Other persons, including doctors, report that they had been able to "produce two days' work in one" after taking the drug.

Additional drugs are causing excitement in relation to human minds.

Among the most important of them is LSD—lysergic acid diethylamide—one of the most powerful drugs known to man, and trade-named Delysid.

The drug was brought to light by Dr. Albert Hofman, a chemist in the Sandoz Pharmaceutical laboratories in Switzer­land. He was investigating derivatives of ergot, which caused the terrible outbreaks of St. Anthony's Fire which centuries ago caused victims to suffer horrible muscular spasms fol­lowed by gangrenous rotting away of fingers and toes.

The compound Dr. Hofman was working with was LSD. Accidentally, he swallowed some. Later, at home and in bed, he experienced a "not unpleasant state of drunkenness," with amazing sights, wild displays of color, and other hallucina­tions. He deliberately experimented more.

Later, other scientists investigated the drug and found that a remarkably small amount—25 millionths of a gram—could "transport" a person back to his childhood.

Other drugs such as mescaline, from the button of the peyote cactus (from which Southwest Indians make mescal, a stimulating drink), may be effective in somewhat the same way, but it is only about l/5OOOth times as strong and may bring nausea. The so-called "truth serum"—sodium pentothal —also has "memory call-back" potentialities, but in no way compared with those of LSD.

Psychiatrists have found that LSD is an important aid to short-cutting psychotherapy since it apparently has an incred­ible power to quickly remove inhibitions and allow the patient to go back and to live again the submerged, hidden experi­ences of his early childhood.

Although somewhat still in the investigational drug classi­fication, LSD apparently works exceedingly well in combina­tion with psychotherapy in many cases. It must be handled with great caution, and doctors who intend to use it usually take it themselves many times so that they will be fully acquainted with its actions and will anticipate its action upon patients.

Thousands of doses of LSD have been given and doctors have carefully worked out safety limits within which the drug may be used.

LSD is especially effective in treating the more common neurosis as distinguished from psychotic conditions. Mainly it is used in cases of anxiety, depression, alcoholism, com­pulsive and obsessional behavior.

Conclusions about LSD still are open to conjecture and probably will not be firmed up until more exhaustive study is done. Drs. Arthur L. Chandler and Mortimer A. Hartman, of the Psychiatric Institute of Beverly Hills, have reported using it as a "facilitating agent" in treating patients.

About it they have said, "It has been possible to 'reach' and work with patients who are otherwise unresponsive to psychotherapy." They reported that they had several patients who had derived small benefits from as much as six years of ana­lytic therapy, but who were either discharged or remarkably improved after 20 to 40 LSD sessions.

Dr. Ronald A. Sandison, an English psychiatrist who has supervised administration of more than 3000 doses of the drug, observes of the new events in drug therapy: "I believe we may be on the threshold of a new era of treatment, now that we are commencing to gain access to drugs which compel the unconscious, willy-nilly, to unlock its secrets."

Hypnotism offers another aid in working with mental cases.

It is interesting to note that Sigmund Freud, who is credited with introducing psychoanalysis, first began his studies and work in psychiatry with experiments in hypnotism.

As a student he heard Dr. Joseph Breuer describe how a woman patient who suffered from nervousness was placed under hypnotism and talked freely and deeply of her diffi­culties.

Other treatments had failed to help the woman, but now under the "talking cure" she was getting well.

Later Freud applied hypnotism to some of his hysterical patients with good results. In 1895, in collaboration with Dr. Breuer, he published a monograph on hypnotism.

Somewhat in the same way that drugs may release the barriers to the hidden depths of the mind, hypnosis has served to help patients recall disturbing events and conflicts that have caused their present mental difficulties.

One report concerning a 30-year-old woman treated at the Menninger Clinic states that she had suffered for seven years from acute neurotic symptoms. With hypnosis treatment she was able to recall the conflicts and disturbing events that had caused her trouble. (Hypnotherapy, A Survey of the Litera­ture, Dr. Margaret Brenman and Dr. Merton M. Gill.)

Many other instances may be found where hypnosis has enabled a therapist to "reach" a patient and bring out the trouble-causing conflicts and events that gave seat to a mental problem.

Hypnosis was especially valuable in rehabilitating men who broke under emotional and mental strain during World War II. As a result, many fighting men who would have been tagged as "shell-shocked" in the terminology of World War I, recovered and returned to duty instead of being sent home as permanent mental casualties.

Frequently hypnosis combined with psychoanalysis, a tech­nique sometimes called hypnoanalysis, is most effective in cases that demand short but penetrating psychotherapy.

"Hypnosis has a legitimate and valuable place in the prac­tice of medicine. However, like any drug or therapeutic agent, it can be misused and abused," warns Harold Rosen, M.D.,

Chairman, Committee on Hypnosis, American Medical As­sociation.

"It is essential that anyone considering hypnosis—and this includes the physician and dentist as well as the patient—do so with full awareness of its limitations and dangers. Any physician who uses hypnosis should have supplementary train­ing in basic psychiatry over a prolonged period of time at an accredited medical school or teaching hospital. A physician or dentist who attempts cases beyond his professional com­petence may unwittingly harm the patient be believes he has cured. It goes without saying that the person who seeks 'hypnotic treatment' from a lay person is playing with psychic dynamite."

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