You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
In the psychic structure we must consider tuberculosis as one of the factors as well as age, profession and constitution. In patients condemned for many years to inactivity in a sanatorium a certain psychic state is to be found. Berger analysed a great number of tubercular people, chiefly males, who were in sanatoriums, and in different layers of the psychic structure he found elements for which the tuberculosis would certainly account. At the beginning of the disease, especially if it is of sudden onset, there is found a marked depression which, although justified by the illness, receives an exaggeration by the patient. Then, after the diagnosis is confirmed, there appear distinct neurotic symptoms which often increase during the stay in the sanatorium: the patients become ill-humoured, irritable, egotistical in their behaviour, psychically labile, either of childlike optimism or of negativism with persistent lamentations. The analysis proves that there are disturbances of the libido: religious ecstasies demonstrate the driving for sublimation of the sexual instincts, infantile love for objects and narcissism are signs of regression. It is difficult to separate tubercular neurosis from hysteria: to the latter belong restriction of consciousness, dissociation of personality and 'mitomania', that is, imitation of organic symptoms like coughing, fever, hemoptisis. Hysteria itself creates the syndrome; tubercular neurosis increases and changes the organic disturbances, for it belongs to the traumatic neurosis (Kraepelin). Tubercular neurosis depends upon a conflict which carries on the overcoming of the regressed libido by aggression instincts. In this way there results a rebelling, discontented behaviour against the world or a kind of slow suicide by disobedience of medical orders. Here the analysis can have a saving effect.