Gentlemen!

Just as the clinical picture of Affective melancholia—which we derived from experience—is fully explained by assuming an intrapsychic loss [Ed] of function, so we also encounter, albeit less frequently, an acute mental illness that, in all its symptoms, may be derived from an opposite state—of intrapsychic hyperfunction [Ed]. We call it mania, and have an example in the recently presented patient Pr. Let us now consider its individual symptoms more closely.

Aberrant facilitation and acceleration of ideation, corresponding to the concept of intrapsychic hyperfunction, is manifested chiefly as flights of ideas [W]. It is not merely a more rapid flow of the chain of thought between A and Z; for such would not seem to us aberrant and would indicate, rather, a desirable increase of psychic ability. The prerogative of mental giftedness or of genius depends essentially on the unusually rapid and more extensive thoughts within the same timespace than is available to mediocrity. We describe wit, speed of repartee, presence of mind, versatility of interests, and other valued attributes of prominent people in this way. In contrast aberrant facilitation of ‘acts of association’ [Ed] produces the inconvenience that the train of thought is no longer strictly closed, as it is in the normal state, as represented by the well-worn path AZ, but that each link of the association chain extending from A to Z may afford the starting point for trains of thought, which correspond to secondary associations, which are normally suppressed. In my introduction, I developed the idea that a strictly terminated train of thought is the result of practice and training, that is, of functional acquisition. In general, however, where more complicated trains of thought are being modified, a degree of self-control or collectedness is needed to suppress all secondary associations which might disturb the main one. As long as this ‘circumspect collectedness’ [Ed] is not lost, secondary associations may be noticed to an intensified degree, and yet the main association is retained. This possibility exists particularly in highly trained minds. This results in a greater abundance of thoughts, a state of increased productivity, and eventually actual improved ability, as can occasionally be seen in initial stages of the abnormal state to be described here. Particularly in Homo tardus [W], a mentally sluggish, and unproductive individual, a beneficial change in the whole personality may be produced in this way for a short time. We could then speak of a ‘coordinated flight of ideas’ [Ed].

Usually, however, the flight of ideas reduces an individual’s ability, in that it robs him, or limits his ability to retain the main association. The flight of ideas then becomes uncoordinated. Thus rational judgment of actual ability is lost, and a feeling of increased capacity arises, the counterpart of the subjective feelings of inadequacy in melancholia. While the latter leads to feelings of misery, here it induces feelings of happiness, to the point of abnormal euphoria; but here too, assuming that some degree of psychic ability prevails, self-awareness of the change in personality may be enabled—an autopsychic paraesthesia in the above sense. Consequently, the Affective state of abnormal euphoria which determines the clinical picture often shows up as transitions to autopsychic disarray. If the patient can be stabilized, at least for a moment, it may be possible for closed trains of thought to occur, perhaps by dint of strong efforts on attentiveness, and when requirements are not too difficult. If the disturbance exceeds such limits, the flight of ideas becomes not only uncoordinated, but incoherent. The result is a disconnected jumble, so that any possibility of intense Affective states is abolished. Flight of ideas in severe degree—the counterpart of depressive melancholia—leads to a state of confusion, without a definite, controlling Affective state, the ‘flight-of-ideas confusion’ [W] according to some authors, to be met again under the heading of ‘confused mania’ [W]. It is an intensified mania, a clinical picture that exceeds ‘Affective mania’ [W]. The justification for making this distinction, as much as any practical requirements, meets the needs of our theoretical derivation, demonstrably so, in that, in mania, we often observe transition of one state into the other. The connection is much more certain here than in melancholia, where I suggest that the depressive form, as a symptom complex, may be independent of the Affective form, and needs to be considered separately. However, mania is often limited just to the milder form, without progressing to the point of incoherence; and in what follows I will always have in mind just this, when I speak simply of ‘mania’ [Ed]. ‘Confused mania’ [Ed] will be given separate consideration.

Certain other symptoms are closely connected with abnormal euphoria: These include increased self-assurance, manifest in a pretentious appearance, a domineering manner, or a sense of superior knowledge and understanding. A degree of intrapsychic hyperkinesia is the counterpart of akinesia in Affective melancholia. In fact everything seems just as easy for a person who is manic as it is hard for one who is melancholic. Autopsychic disorientation takes the form of grandiose delusions, and a patient claims for himself attributes, property, offices, and functions which do not match reality. Nevertheless, such manifestations of grandiosity usually remain within limits not far removed from what is possible, or which are manifest only conditionally, as opinions and expectations, or which are expressed ironically, as though the patient were joking, and indulging in ‘make-believe’ [Ed]. Not uncommonly however, grandiosity reaches excessive proportions, and even fantastically grandiose ideas, arise sporadically, yet never fixed, changing from day to day.

Abnormal euphoria is sometimes permanently combined with a tendency to irascibility. At other times it may be interrupted by irascible Affects. Both of these are understandable, in that the exacting, obstinate, and domineering characteristics of this illness naturally arouse people’s opposition, which enhances anger. If the irascible Affect does become permanent, it seems to be due either to physical maladies, or to long-continued, improper treatment by other people.

Increased activity in the process of association brings two other sequelae [W] to the fore, which show plainly the contrast with melancholia. A patient’s interest in all events they witness, and their readiness to follow up on any outside suggestion is increased. Growing out of the increased thought activity, is to some extent the need to sustain stimulation. This mental disposition may be confused with hypermetamorphosis, but is entirely different, as we will see later. Similarly with the second sequela, the increased ease in taking decisions, and the tendency to transform decisions rapidly into action. The consequences of this are enterprise, drive, and interference in affairs of others. On the ward, these two attributes in combination are enough to produce the greatest uproar.