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JAMA 100 Years Ago
September 18, 2002


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2002;288(11):1416. doi:10.1001/jama.288.11.1416

Despite the general interest instinctively taken by the public in medical subjects, the important principles of medicine seem to become common knowledge only slowly, more slowly, indeed, in many respects than the "greatest good of the greatest number" would demand. In this direction the medical profession undoubtedly fails somewhat to do its whole duty.

One direction in which this lack of public enlightenment on truths recently developed by scientific medicine is of especial import is that as to the general nature of mental derangement. Ask the average man to briefly describe a dangerous case of insanity, and probably he would depict acute mania in its violent stage. This still to the lay mind is the typical form of madness, and the one he fears most to meet. On the other hand, the average man has a good notion of what a "crank" is, and cranks are to him a source of mirth and of innocent merriment; he has not yet learned to fear them. It is the relation of crankiness to what he already recognizes as madness that is most lacking in the public's psychiatry. In short, the people need to be taught (and who but the physician can teach?) that, other things being equal, the crank developing into the paranoiac is worse deranged and far more dangerous than even the maniac who raves. In the maniac one discovers only, in type, a quantitative disturbance in normal psychophysical function, while in the paranoiac the disorder, while almost wholly mental, is at the same time qualitative. It is on this latter account that monomania involves possibilities of motor ideation and of consequent conduct which may entangle, and that most dangerously, all with whom the patient has to do.

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