Imagine a patient without this regulating faculty: a brain without a brake, without direction, in a state of total anarchy. Carried away by every impulse, vulnerable to all kinds of phobias, unable to reason or judge, forced to accept all the impressions received by the subconscious mind... such a person would be no more than a miserable wreck, living a life of constant suffering. Fortunately, complete lack of control is an extreme case which is rarely encountered in the patients
we treat; what we usually find in cases of psychoneurosis is an insufficiency or instability of control.
Insufficiency or instability of controlIn cases of insufficiency, control exists as a faculty, but either it has not reached full development, or it is defective in some way, or its influence is not adequate. In such cases we can see that some of the
ideas or impressions experienced by the patient do not pass through the filter of the conscious brain.
These persons may be able to reason or judge in a normal way, yet remain dominated by ideas or impressions which they know are absurd or exaggerated, but over which their willpower has no control.
This is the situation of a typical psychasthenic patient. In cases of unstable control, the situation is basically the same:
here patients shift from a normal state to a diseased state, for no apparent reason. Symptoms appear and disappear in more or less close succession. A period of critical depression may be followed by a period of gaiety, and all aspects of the personality are subject to change -it can affect patients’ physical health, their character, or their thought processes.
There are an infinite number of degrees between a total absence and an insufficiency of control, giving each case its articular character. These differences are of interest when diagnosing and prognosing an illness, but it would be useless to describe them all here since, in practical terms, it is enough to determine whether control is sufficient or insufficient.