Obsessional Disorder and Neurological Illness.

Obsessions and compulsions are mental experiences with a compelling quality which persistently intrude into consciousness. Although recognized by the patient as an abnormal and irrational product of his own mind, and resisted by him, he is incapable of expelling them. They may take the form of thoughts, images, fears, urges, desires, or acts. An obsessional illness is one where such symptoms dominate the clinical picture and are not associated with any underlying psychotic process or phase. Since the end of the last century, attempts have been made to understand obsessional disorder in neurological terms. Gadelius (1896), in Sweden, considered that obsessions were exaggerations of normal mental functioning and compared them with suggestibility and contrast thinking. He believed that every idea had a counter-idea, like an echo. Postulating an organic brain lesion, Gadelius suggested that the former had a cortical, the latter a subcortical, origin. Where there was a constitutional tendency for cortical weakness, subcortical centres were released from higher control and obsessional phenomena appeared clinically. An organic explanation for obsessional symptoms was subsequently advanced by a number of writers, particularly Goldstein (1924), Wexberg (1929 and 1938), and Schilder (1938). This theory gained ground from the work of Mayer-Gross and Steiner in 1921. They found symptoms similar to obsessional in postencephalitic Parkinsonism. A number of other investigators later confirmed this finding (Ewald, 1924; Falkiewicz and Rothfeld, 1925; Scharfetter, 1926; Stern, 1927; Skalweit, 1928). The present study represents part of a clinical, social, and prognostic inquiry into obsessional disorder. In investigating the medical history of patients suffering from such an illness, an attempt was made to discover the incidence of previous neurological disorder. This, it was felt, might throw some light on the possible connexion between obsessional symptoms and disease of the central nervous system.