break off and discontinue old associations and reactions which are harmful and contribute to prolong and aggravate the mental disorder, and to form new associations and reactions which by repetition will become fixed in habits which will aid in the restoration and promotion of health. Just as an undesirable act is best controlled by having the patient utilize the energy in doing something else, so morbid trains of thought can best be controlled by substituting for them other ideas and associations which are healthful. The power of will is limited and cannot for long exercise control over the thoughts by merely driving them out and keeping them out of mind, unless other ideas are put in their places, and it is only by persistent, patient effort, put forth again and again in spite of hindrance and failure, that one is able to get rid of old and disturbing trains of thought, for they tend to recur so surely in response to old stimuli. A change of environment from home to hospital often proves very beneficial for this reason. In the old environment impressions and influences which may have been precipitating factors in the mental breakdown are ever present and are continually operating to keep the morbid impulses active, but in a new and different environment among new surroundings and people they have not known, new modes of behavior are demanded and new ideas and trains of thought are created which interfere with and interrupt the old associations, so they recur less and less frequently, and gradually are so weakened by disuse that eventually they disappear from consciousness.

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For the patient who is struggling to break off and get rid of old, undesirable and harmful habits of thought and conduct, committing to memory the little poem by John Boyle O'Reilly, How shall I a habit break," has been found to be a very practical nursing measure, for it has helped to exclude old thoughts and interests, to increase the courage, to strengthen the determination and to bring about a happy result. For the convenience of those not acquainted with it, this poem is inserted.

Emotions. There is a law in psychology that whenever an idea comes into consciousness it tends simultaneously to produce an associated feeling which impels one to make certain appropriate movements or reactions. The feeling may be pleasant or unpleasant, depending on whether the response to the impression or idea has in the past been accompanied by a pleasurable or disagreeable feeling. Ideas which are associated with or accompanied by certain definite feelings either of pleasure or pain, meaning discomfort, unpleasantness or dissatisfaction, are termed emotions. All experiences tend to become associated with definite feelings or emotions and are colored by them.

The origin of these feelings has been explained in this way: When the response to any impulse is adequate, a pleasurable feeling is produced, and the idea which produced the im

pulse and the feeling tends to disappear from consciousness; when it has been repressed or inhibited and so fails of adequate expression a feeling of unpleasantness or dissatisfaction is aroused; and when it has been blocked by some external force so that action is hindered or denied, other and stronger feelings are engendered which demand more vigorous reactions. Therefore, psychologists have established the law that the reaction to an impulse or desire must be sufficient to satisfy fully the demand of the emotional feeling. An instinctive tendency like imitation, finding expression in copying the acts of others, arouses the feeling of admiration, but when it is balked or frustrated in its execution a feeling of vexation is created. When curiosity is blocked, there is produced a feeling of perplexity; pugnacity, normally arousing a feeling of resentment, may be converted, when frustrated, into anger and frenzy; when the gregarious instinct expressed in sociability fails of realization, a feeling of homesickness is produced; when rivalry is blocked, feelings of envy and jealousy are created; and the sex instinct failing of adequate expression gives rise to feelings of sex jealousy. In like manner every instinctive impulse or desire may result pleasantly or unpleasantly, depending on the adequacy or inadequacy of the response.1 Pleasurable emotions are exhilarating and stimulating, for they arouse the mind to greater activity, inspire confidence and courage, and incite to more vigorous muscular activity. They are, therefore, useful in creating new ideas and interests which produce new activities. The unpleasant emotions tend to have a depressing effect, for they lower the vitality, produce mental fatigue and inertia and greatly diminish the bodily activity. They, too, serve a useful purpose, for old habits of thought and conduct which "have dulled the mind and mechanized the behavior, are at least temporarily interrupted and the opportunity is thus offered for a new start and the gradual formation of a new set of habits and new attitudes of mind."

1"Human Behavior," Colvin and Bagley.

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Emotions demand vigorous expressi and produce numerous and usually intense bodily actions. The child, when happy, jumps and skips; when hurt or grieved, weeps; and when angry, kicks and strikes; but as experience increases the expression comes more and more under the control of the will, and self-control or mastery of the emotions is a very important factor in the education to health. In diseases of the mind when the normal function is deranged, loss of emotional control is among the early symptoms.

Mood. Emotional experiences make a strong impression on the mind and tend to persist and linger in consciousness, and so remain active in influencing and dominating the attitude of mind. Mood is a temporary state of mind which may be changed or terminated by conflicting or stronger emotions and by voluntary interference. The feelings are subject to the law of habit, for the indulgence of one sulky, gloomy or unhappy mood predisposes to and makes more easy a recurrence.

Temperament. Heredity gives to each individual certain physical characteristics of feature, form and coloring; it also gives him certain personal peculiarities or characteristics of mind which are forceful in determining what the permanent emotional attitude or temperament shall be. Hippocrates, 460 B.C., recognized and explained the origin of four different temperaments. His explanations were long ago rejected, but the names he gave are still applied to the four traditional temperaments. These are: Sanguine, or sanguineous, applied to a person who is bright, lively, cheerful and easily excited to action; choleric, one who is impetuous, easily moved to anger and vehement in action; melancholic, one who is habitually unhappy, gloomy, sad and depressed; and phlegmatic, one who is dull, listless, indifferent and very slow to act.

The tendencies and characteristics given by nature and ingrained in the physical organization are perpetually being energized, antagonized and annihilized by the physical, social, intellectual and moral forces of the environment so that

they are modified, changed and molded into other tendencies and reactions. While the question whether heredity or environment is the more powerful in determining the permanent mental attitudes is being discussed and argued, both must be acknowledged to be important factors in the causation of the functional mental disorders. There are some types of mental make-up or constitution who, while not directly predisposed to mental disease, seem less well able to withstand strain and worry, fatigue and overwork, disappointment, sorrow and misfortune, for whom the readjustments and adaptations demanded by an ever-changing environment are more difficult, and under stress the nervous mechanism becomes disordered. These have been termed the psychopathic personalities.

Psychiatrists affirm that these personalities show tendencies so characteristic of the different constitutional or functional psychoses that they indicate the form of mental disease to which they are especially liable, for it has been noted that the earlier traits and characteristics tend to persist throughout the period of mental illness and the symptoms are many times but exaggerations of these tendencies. A person who early in life shows a lack of ability to readily adapt himself to changes in the environment, although bright, even precocious intellectually, and tends to become reticent and seclusive, less interested in the world about him, more concerned with his own thoughts and interests, and for whom the responsibilities and requirements of life make demands he cannot efficiently and adequately meet, may in order to escape from the situation develop a mental disorder, dementia præcox, for by this means he gets away from the requirements of reality by creating a new and imaginary world in which he can live more favorably. One who does not get along well with other people, is conceited, selfish, easily offended, quarrelsome, feels he is not fairly treated, that he has not an equal chance in the world, shows characteristics which may become stronger and more fixed and develop into the delusions of the paranoic. One who is