Two men were talking about a mutual friend. They were discussing certain saddening developments in the friend’s life. For some reason the friend wasn’t doing well in his work. He seemed to be failing in h is ability to meet his problems, and that for no adequate apparent reason. He seemed to be taking to the technique of running away from any troublesome problem that might confront him. The parting remark of one of the two men about their friend was this: “Poor chap; he seems to have lost his grip.”
Such a remark may refer only to a temporary lapse in a sustained effort. Most people have a feeling at some time or other that they have “lost their grip.” And such a realization commonly leads to a more vigorous assault on the work at hand.
On the other hand the observation that some one has “lost his grip” may have considerably more meaning than a passing episode in any human life. As has been pointed out in previous articles in this series, it is perfectly proper to think of mental health or ill-health in terms of the nature of the contact a person has with his total life situation. In this sense the common manner of expression used by the man concerning his friend has considerable merit.
Does a person deal with his responsibilities and his problems in a direct and effective manner? Does he show that he has things well in hand, has a firm grip on them? Does he know what he is trying to do and does he show that he has some clear notion about doing it? Does he tackle his responsibilities resolutely, or does he tend to shy away from them? These and similar questions have much to do with the whole matter we are discussing in these articles.
Organic Reaction Types
In the previous article it was pointed out that one may “lose his grip” on his life situation for one of two general reasons. It was indicated that there may be some damage or fault in the central nervous system (brain and spinal cord) which causes mental disturbance. Such mental disturbances are called organic reaction types. On the other hand the mental disturbance may be traceable to no physical cause and is an outgrowth of faulty emotional development. Then we have mental illnesses known as functional reaction types.
In order that we may see the pastor’s task in its proper light in this whole area or personality health we shall deal with these matters somewhat more fully. As we do, we would have the reader bear in mind what was said in the previous article. The treatment of both of these general types of mental disturbance is primarily and often exclusively the work of a qualified medical doctor trained in psychiatry. This point will come up again in the sequel.
It will serve no good purpose to discuss the organic reaction types in detail. Only a man expertly trained in the structure and function of the central nervous system could discuss these matters intelligently. The present will certainly recognizes his obvious limitations here. Also, there are strong reasons to be brought against such a discuss ion in a magazine intended for general and popular reading. Therefore we shall merely list the main categories under the organic reaction types.
A . Psychoses with primary degenerative brain changes. (By primary is meant changes originating in the brain itself and not resulting from the action of some foreign agent upon it.) Example: psychosis with cerebral arterioscleros is (hardening of the arteries in the brain.)
B. Psychoses with organic brain diseases Example: psychos is with certain cases of brain tumor.
C. Psychoses with brain injury.
D. Psychoses with toxins or infections. Example with toxin: Korsakow’s psychosis, resulting from chronic alcoholism. Example with infection: general paresis, resulting from certain cases of unarrested syphilitic infection.
E . Psychoses with endocrine disturbances (having to do with the glands of internal secretion). Example: psychosis with certain cases of hyper-thyroidism.
Further reference will not be made to the organic reaction types. Anyone wishing to gain more detailed information about these types of mental illness can consult a standard text like A Textbook of Psychiatry by Henderson and Gillespie; Oxford University Press, 1951. A word of warning is in place, however. One who does not have a good measure of expert knowledge in this field should not dabble in the symtomatology of mental illness. This territory belongs to the medical doctor trained in psychiatry. The complexities of this subject hold many perils for the unitiated.
Functional Reaction Types
In trying to gain a preliminary idea of the functional reaction types we return to one notion of the “grip” on reality or life. And we can illustrate the variations in the “grip” (or lack of it) on life by thinking of one’s “grip” on the steering wheel of a car. Although we have here only an effort at illustration, yet the illustration we arc about to use has merit because a car is very much live. It is a dynamic something and one’s grip on it is fraught will tremendous possibilities for pleasure or for pain, for success or failure, for life or for death. In this way the car is a fairly apt symbol of our life situations. Life is not something static. The situation is always alive, dynamic. We have to adjust constantly to changing demands, people with their varying requirements and wishes, economic conditions with their ups and downs as well as to our own inner stresses and tensions.
If a man is to drive a car he must, of course, actually grip the wheel. Propelling a car along a road at some considerable speed with the driver’s hands not actually gripping the wheel is a situation fraught with great peril and will probably end in disaster.
One of the functional reaction types especially is suggested by the thought or a car’s moving along without the driver’s hands gripping the wheel. This type of reaction is called schizophrenia (formerly dementia praecox). In this type of mental disturbance there is very little and sometimes no contact between the personality and the situation around him. In this instance it is often correct to say that he has literally “lost his grip.” The ill person may live in a world all his own, his feelings and thoughts drifting around in a world of fantasy. He smiles when there is no apparent reason to smile. He laughs when possibly he ought to cry. Under modern methods of treatment many such cases recover. If such a person does not recover he may lose contact with reality more and more until finally his life seems not unlike that of a vegetable. There are hosts of such pitiable creatures in our nation’s mental hospitals.
Now let us visualize a very different situation. Here is a man whose grip on the wheel is far too tense, and he drives like mad. He travels at a furious pace, taking all kinds of reckless chances in congested traffic conditions. He drives like a man that is running away from something. Then again, he may drive in a manner quite the opposite from that just described. He may move along at a snail’s pace, hardly moving at all. He drives like a man that seems almost dead. He certainly seems to lack the pep that is needed to move along on a busy highway. As a matter of fact, he should be off the road. He just doesn’t belong there.
Such a driver suggests another type of functional reaction, namely, the manic-depressive type of reaction. Such people are not out of touch with the realities of life in the sense that those suffering with a schizophrenic type of reaction are out of contact. Their hand is not completely on the wheel. Rather, they seek to escape certain realities in life by dashing at breakneck speed through life, thus avoiding the matter that is painful to them. Or they may become depressed, unable to rise to the challenge of life. They may sink into an utter despair and helplessness, asking to die.
A driver that is very much like the ones just described is the person who can’t keep his grip on the wheel in the middle years of life. Because of the special physical and emotional tensions of the climateric (menopause) such a person may to a greater or lesser degree lose her or his grip on life. Most people travel along very well at that stage of life. Some do not. Such people may suffer severe depression. For that reason they are sometimes listed under the manic depressive reaction type. The illness from which they suffer is usually called involutional melancholia.
The next type of driver is very different from those we have mentioned so far. He is a type that seems to be traveling along very well. His grip seems good. Then he may beg in to act strangely. His grip on the wheel gets taut. He looks around. He looks around again. He seems to think somebody is following him. Yes, there’s a green car that he has seen a few times of late. The driver of that green car had looked at him in a strange sort of way. He goes faster. Then he begins to act very ingeniously. He furtively turns down a side road, and through a series of very shrewd turns he throws his imagined pursuer off the trail, for the lime being.
This driver suggest the paranoid reaction type. He is suspicious. He is sure there is a gang of men working against him, undermining his reputation, seeking to wreck his home and his business. He must be on guard against them. They may hurt him and his family: they may hurt others. They may hurt the president of the United States. He must warn him of his danger. He finds evidence in some strange phrases in the newspaper that the president is in danger. There is another type of driver, a strange type indeed. His grip is excessively tense at times. But more often it is too relaxed. He drives as if he is the only one on the road and all have to look out for him. He doesn’t control his car well. It follows an erratic course. Such a driver suggests the mentally ill person that is called the psychopathic personality. He is like the other people we have mentioned, and yet he is different. He is only self-centered. The world turns around him. He seems to know a lot of things and yet he doesn’t seem to be able to make the best use of his knowledge. To use our figure once again, he seems as if he ought to be a good driver, but in actuality he is a very poor one. He wants the whole road. He acts much like a drunken driver.
The Neurotic Personality
There is another type of driver whose characterization is not easy. He drives tolerably well. He is fully alert to all the important factors involved in driving. As a rule he does not disregard the laws of the road. He reckons with traffic conditions. He is not likely to do something which prompts another driver to shout at him with words like “Are you okay, bud?” He knows what is involved in driving a car and he does his best to handle the car accordingly.
Yet he is not a good driver. He is not wholly poised. He gets excited when trying to park. He can’t stand to have someone give him a blast of the horn in tight traffic conditions. He tends to be excessively cautious at times. In general it may he said that he drives in such a way that other drivers instinctively become a bit more cautious when they get near him. They are not wholly confident about his reactions. It is to be hoped that no one will be highly annoyed as the writer suggests that the type of driver we are discussing handles his car in the manner that men sometimes feel is characteristic of the woman’s manner of driving, It is farthest from our thoughts to enter into a debate on the relative merits of men’s and women’s driving of a car. We mention this well known notion of some men to illustrate our point about a certain type of personality. And, we must add this type of driver generally is conscious of the fact that his driving is not what it ought to be, but he seems to be unable to correct it.
Here we are speaking of the neurotic type of personality. This type is different from the psychotic personality. The difference between these two is not exactly one of degree, The neurotic personality does not actually lose his grip on life. He remains in touch with his surroundings. His grip is often shaky, unsure. And generally his behavior is not unusual in any marked way. It does not appear bizarre or irrational to others. Unlike the psychotic personality generally, the neurotic personality commonly has some insight into what is wrong with him but is unable to do anything about it.
Just because of this fact together with certain factors in the illness as such, the neurotic personality may suffer very intensely, The psychotic personality often finds escape from suffering by denying or withdrawing from “reality.” The neurotic personality does not do this. He has another wholly unconscious and highIy subtle technique. He converts that which is mentally painful to him, his conflict, into mental or physical symptoms that he as a person finds more bearable or acceptable. A most striking illustration of this “technique” is the paralysis of the right arm of a man who has long hated his job (in which his right ann is essential) but he hasn’t the courage to give it up to seek a new one. The paralyzed arm, in a way of which the person is wholly unconscious, solves two conflicts for him. It takes him out of his hated jobs and it relieves him of the grave responsibility of stepping alit of a secure position into the in security of seeking new employment.
This discussion gets us into a consideration of what is involved in the development of faulty personality reactions. With that we must deal more fully at a future date.