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During the Civil War in Spain an enormous number of cases of pellagra developed in Madrid, due to the failing food supply. Under these unhappy circumstances I had the opportunity to study the mental disturbances produced by avitaminosis, from the initial stages until their end. The study has brought me to certain conclusions that I consider of great theoretical interest for psychiatry in general. In a word, it has convinced me of the need of a revival of the old concept of a unitary pattern inherent in all psychosis—“psi-cosis única”—although with certain important modifications as will presently be shown.
Before the general theoretical considerations are explained, however, a brief resumé will be given of the observations which I made on psychosis in pellagra and which form the basis for such a concept.
As manifesting symptoms of pellagra we find not only the psychic syndromes which have been called by Bonhoeffer “forms of exogenous reaction,” and whose non-specific character is obvious, but also those psychic states that qualify as endogenous, and are attributable to internal dispositions, hereditary or peculiar to the individual.
These different psychic states do not appear in an arbitrary or disconnected fashion, but pass by imperceptible stages of transition from one to another, in a determined order, and in correspondence with the gravity of the situation as a whole. First to appear are the neurasthenic psychic states; then thymopathic states (depressive, manic or paranoid); and later there follow schizophrenic states, and states with a dream-like disturbance of consciousness; last of all
* From the Psychiatric Clinic of the Provincial Hospital, Madrid.
come states of deeply clouded consciousness, profound obnubilation, which often terminate in death. We see then that all these psychic states are not only essentially non-specific in character (whether or exogenous or endogenous coloring) but also they appear in stages of transi