Article I: On Various Diseases of the Mind: Brief Notions

I. What diseases of the mind are. In this place we treat of those infirmities which permanently or transitorily take away or diminish free choice, and which are called diseases of the mind, not because the mind itself, or the spiritual faculties, can be diseased in themselves, but because, on account of the badly affected centers of the brain and the sensitive powers, especially the phantasy, which they use, they are subjectively impeded in their action. Indeed, apart from its depraved habits, which do not take away liberty, the will is not impeded otherwise than by the intellect being impeded. "Insofar as reason remains free and not subject to passion, so far the motion of the will which remains does not tend of necessity to that to which passion inclines." Thus St. Thomas already wrote accurately, 1, 2, q. 10, art. 1.

II. Division. These diseases are called organic when some lesion is found in the material organ; but functional, those which allow the body to be truly or apparently intact.

They can be reduced to a twofold generic form, since some seem to affect the higher faculties more directly, others rather indirectly, insofar as you would say that by the impulse of the lower powers the higher faculties are imperiously drawn. But they are not drawn except because, by a subjective impediment, the higher faculties have been made weaker, so that they now cannot restrain the lower powers. Wherefore these various diseases are finally of one kind. Let us hand down these few things about most of them.

Phrenetics set forth false judgments which are radically incurable, because they are deceived by perpetual or temporary hallucinations, or at least they have disturbed phantastic associations, so that their psychic life can be equated with the life of those dreaming. In the delirium itself, even if it seems circumscribed by one subject (monomania), they are not free. During the intervals of deliriums, nothing per se impairs liberty.

The demented labor under a certain often increasing imbecility and dullness of mind. Whether they are "idiots," or whether their powers have been exhausted by old age or infirmity, they labor under a more perpetual privation of free choice.

Obsession so occupies the mind that the obsessed person is constrained to think or to do certain things. And it disturbs practical judgment enough that it allows place only for light fault. But besides perpetual obsessions, others arise only in certain circumstances. Wherefore, outside the state of obsession, the sick can freely violate the precept concerning the fleeing of occasions of morbid excitation for committing indecent things.

When there is question of an object toward which there is no natural inclination, the sick person, by repeated acts demanded by the obsession itself, can as it were tire it out, exhaust it, so that morbid anxiety is removed and thus the agent is freed from obsession. But at the same time, through repeated acts, the propensity is increased if any such propensity arises per se from the object. Wherefore this method cannot be applied in a sexual matter, as the physicians Pitres and Regis themselves warn ¹.

¹ Les Obsessions et les Impulsions. Paris, 1902.

To this are referred impulses which are called invincible; and such impulses can exist in a morbid state, whether they obtain an immediate and non-deliberate act, or whether the act is elicited after fruitless resistance. They suppose a person especially capable of passive induction, or "suggestible." This excessive docility depends upon the abnormal intensity ("developpement") of some phantasm: if that phantasm is of an action to be done, or of a motion, it will easily beget an insuperable impulse.

The praised physicians Pitres and Regis distinguish: a motor impulse, merely mechanical, which is often without affection, as for example in an idiot; a psycho-motor impulse, which is accompanied by a more distinct perception of the thing and a stronger commotion of the appetite; a psychic impulse: then the act does not always or necessarily occur; it is in the power of the agent to resist the impulse.

And so it is not easily discerned whether impulses were irresistible or not. They are to be judged such when the action cannot be explained by natural concupiscence. An invincible impulse also seems to be present if, after the evil action, the mind has remained quiet and content. But the matter is far more uncertain when the propensity is borne toward those things to which healthy men also are inclined.

Aboulia renders the will impotent for willing or for commanding efficaciously: either it remains idle, or, as if unwilling, it is forced to seek or flee certain things contrary to its own practical judgments. One who is affected by the former kind of infirmity is often excused from several positive duties. Concerning the latter, there return the things said about blind or invincible impulses.

Epilepsy, not that which is manifested by the customary phenomena of the comitial disease, but that which is called masked or hidden, impels one to perpetrate various strange, shameful, and atrocious things. It is clear that epileptic or hysterical agitation cannot be combined with grave guilt. But outside the times of frenzies, the mind becomes sane.

In the hypnotic state, insofar as someone is truly acted upon by another's command rather than himself acting, liberty also is taken away. In this state an artificial docility for believing, feeling, and doing those things which another affirms to be or orders to be done is induced in suitable persons.

And this excessive dependence on another often remains. Yet this can be avoided by a suggestion of liberty or independence added in the final command. There is also made a moderate suggestion conformable to the useful desire itself of the sick person, who, by this reason, may wish to be healed of certain less good propensities or to acquire a stronger will ¹.

¹ On this argument certain special treatises are usefully consulted, such as those written by R. P. Gemelli, O.M., in Italy, and Prof. Xavier Francotte, in Belgium. Cf. also L. Boone, S.J., Responsabilite normale et pathologique, Revue des Questions scientifiques, 1908; Les questions de responsabilite, Nouvelle Revue theologique, t. 42 (1910), p. 1 and following.

Neurasthenics can be excused rather easily when they yield to a certain weariness by which, as by an excessive burden, they neglect certain positive precepts, especially if these are merely ecclesiastical. Yet per se they are to be judged to sin if, because of sadness, they seek shameful delights to which the disease itself does not impel them.

N.B. Concerning the scrupulous, below, where conscience is treated.

¹ Since new ways of explanation are being attempted, meanwhile we set forth these things circumspectly.