ABSTRACT
We have considered a sufficient number of typical manic cases to show how limited is the range of ideas in this group. We find in the foreground: First, constant talk of sublimations (using that term in its narrower sense of natural activities). These are psychotic, because the element of personal ambition is so stressed as to exclude other considerations and therefore causes a lack of judgment as to the propriety or expedience of these schemes. Second, there may be engrossing religious ideas, which, as a rule, show a primitive and child-like egocentricity, and are often a vehicle for crude expansiveness. Third, the patients may merely luxuriate in fancies of unconventional but adult love affairs. Finally, we hear them speak of a return to childhood with fantastic re-establishment of the nursery attachments in which the element of sex (in its commoner meaning) is eliminated. Then in the background there are scattered references to ideas, necessarily related to the above, of getting rid of those responsibilities, which bind the patient to his adult routine duty. Sometimes these thoughts are not directly expressed, but may be easily inferred from the conduct of the patient, as when a wife becomes highly irritable, perhaps assaultive, towards her husband or children, or when a man abandons his business having antagonism towards his employers and associates in it. These less prominent ideas are not part of the manic content per se, but are ‘vestigial embryonic rests”, as it were, which betray the infantile source of the dominant ideas. In other words, these less pleasant or pleasure-producing ideas do not belong to the manic picture as such, but are related casually with the psychotic origin of the manic content and prove that the manic fancies do not come into being full-fledged, but are intimately related with the unconscious roots of the personality of the patient. It is the maladjustment of this personality, which produces the insanity, and, consequently, sporadic utterances or anomalies of conduct betray the fact that maladjustment is present, while the typical manic ideas and behaviour represent one type of psychotic solution of the difficulties in which the unstable personality finds itself.
