Diagnosis.

F. H.

P. H.

Psychosis.

Mental.

Physical.
Social.

Recreational.

Diagnosis.

F. H.

P. H.

CASE 8

Allied to manic depressive insanity.

Negative.

Female; age 42; born in Roumania; U. S. 10 years; housework; husband and five children.

At first visit to clinic, patient complained of insomnia; was excitable; accused husband of going out with other women; no basis for this complaint. Also accused her mother of personal antagonism. Could not do housework; showed no interest in her children. Threatened to commit suicide on several occasions. About ten similar attacks in fifteen years.

Method

Patient induced to come to clinic regularly where physician examined and advised her. Worker at first visited the patient several times a week and helped her to make necessary mental adjustments. Later, as she showed improvement, she was visited at regular intervals and stimulated to take a wider interest in her home and family.

Examined at clinic and advised.

Patient was very unsystematic in her household work, and since her marriage had never learned how properly to care for home and children. Regular and frequent visits of worker who taught her these things helped materially. Attended to needs of children.

Could only advise. Had not learned nor ever appreciated the value of proper kind of recreation.

Result

Patient had improved very much when supervision was ended. Has continued at this level for a number of years, and stated that the mental hygiene agency has aided her more properly to understand herself.

CASE

Allied to manic depressive insanity.

Negative.

Female; age 14; born in U. S.; public school pupil.

Psychosis.

Mental.

Physical.

Social.

Recreational.

Following the extraction of some teeth, patient became somewhat confused; remained in bed for a month, after which she showed a little improvement. Within a month again became confused, irritable, talked of people following her about and speaking ill of her; very fidgety; shortly thereafter could not talk nor use hands. Parents brought her to psychopathic ward and in a few days she was committed and sent to a state hospital, where she remained for three weeks and discharged in an improved condition.

Method

After discharge from state hospital was brought to clinic and examined by physician. Patient found to have improved very much and return to school advised. Came to clinic several times, being examined and advised. Visited frequently by worker.

Sent to summer camp for adolescent girls maintained by agency; remained there several weeks until she was in good physical condition.

Family moved to better neighborhood; parents were aged and did not understand the patient and her needs. Worker helped to adjust the patient to her parents and to give them another point of view regarding their daughter. By visiting school teachers, worker brought about a better understanding of patient by teachers.

Patient taken to a settlement and interested in a club and in other activities.

Diagnosis.

F. H.

Result

Patient improved very much physically; recovered mentally; no relapse within two years after being taken under care.

DEMENTIA PRAECOX

CASE 10

Dementia praecox, simple.

Negative, except for a brother who is nervous and very irritable.

P. H.

Psychosis.

Mental.

Physical.

Social.

Male; age 24; born in Russia; U. S. 18 years; graduated public school at 14 years; attended evening high school two years; clerical worker, helper in restaurants, odd jobs; single.

Patient first complained of being ill five years before coming to clinic; had many jobs since then but could not hold one for any length of time, being either discharged or leaving of own accord. At first visit to clinic, complained of inability to get along with people, because they passed remarks about him indirectly; attitude and manner somewhat constrained; gave expression to peculiar ideas and in discussing his condition became quite rambling and involved; somewhat evasive in answering questions and expressed delusional ideas of an absurd character. Also referred to some sexual ideas.

Method

Given general advice as to hygiene of mind during visits to clinics. Frequent and lengthy discussions and talks with psychiatrist and social worker seemed to have a salutary effect upon patient; always left the clinic in a better and happier frame of mind than when he came.

Patient suffered from some bladder trouble which rendered him incontinent. Taken by worker to specialists for treatment; also to hospital where patient was kept for about a week. Condition complained of very much improved, though the ailment seemed to have its origin in mental rather than physical condition of patient. Remorse over earlier sexual excesses and masturbation seemingly influenced condition.

Due to mental and physical condition of patient, could not hold any position for a length of time; helped him on a number of occasions to obtain work of a suitable nature, particularly light outdoor work. Did not remain long in any one job, though always managed to earn enough to be self-supporting. Brought about adjustment between patient and his family.

Recreational.

Diagnosis.

F. H.

P. H.

Psychosis.

Mental.

Advised and helped patient join classes in gymnasium, for such exercise as would be suitable to his own condition. Advised as to other forms of recreation.

Result

After four years, mental condition of patient has shown no further deterioration, though certain seemingly chronic neurasthenic symptoms persist. Bladder condition somewhat improved. Patient wanders from one city to another, always returning to New York when he is not well and then coming to clinic. This has prevented continuous, constructive work for any length of time.

CASE 11

Dementia praecox, hebephrenic form.

Father somewhat peculiar in his actions and highly nervous; mother dull; older brother patient in a state hospital with a diagnosis of dementia praecox, hebephrenic type.

Male; age 20; born in Russia; U. S. 10 years; did not graduate from public school; helper and odd jobs; single.

Patient complained of as being very lazy; worked at irregular intervals in many different positions since the age of 14 years. Enlisted in army at 18 years and discharged within ten weeks because of mental condition. Acted peculiarly in a restaurant, was arrested, and sent to psychopathic ward for observation. Mother refused to sign commitment papers and patient was discharged to her custody. Very difficult to manage and get along with at home; unruly; threatening bodily violence to members of family.

Method

After discharge from psychopathic ward, referred to mental hygiene agency. At first visit given thorough mental examination and found to be a badly deteriorated case. Patient expressed desire to enter a state hospital; worker at clinic arranged for his vol

Physical.

Social.

Recreational.

Diagnosis.

F. H.

P. H.

untary commitment, as he refused and mother would not accede to a regular commitment through psychopathic ward. Discharged from state hospital at own request at end of ten days. Mother again refused to have him committed, though father was quite willing to have that done. Very troublesome and pugnacious while in state hospital.

Thorough physical examination at clinic revealed no physical defects needing treatment.

Obtained several positions for patient both in country on a farm and in the city. Had difficulties with fellow workers and employers in every place. Usually discharged within a day. This so discouraged him that he later refused to look for work or report when work was found for him; preferred to loaf in street and around house.

Very difficult to advise because of negativistic attitude, as well as hostility to all doctors and mental hygiene workers.

Result

Very little could be accomplished with a patient in this condition. Patient smashed windows with stones in home of head of organization. Next day sent registered letter threatening life of worker unless sum of $2,500 was given by worker to patient within two days. When arrested at his home a heavy slung-shot was found in his pocket. At police station stated he intended to kill worker unless money was given him within specified time. A commission found him insane and he was sent to state hospital for criminally insane. No improvement after one year residence there.

CASE 12

Dementia praecox, hebephrenic form. Constitutional psychopath.

Negative.

Male; age 20; born in U. S.; helper in dental office; high school 2 years; single.