disorders may last
years. I could name you patients who since thirty years keep the same
obsessions, and who at the age of fifty still ask themselves questions
upon their pact with heaven, as they did at the age of twenty. Shall we
speak of the consciousness the patient has of his state? But this
consciousness may be complete in certain melancholies and very
incomplete in certain impulsions.

Is it necessary to insist on the presence or absence of anatomical
lesions which one tries to ascertain at the post-mortem examination?
Shall we say with Sandras, Axenfeld, Huchard, Hack, Tuke, that neuroses
are diseases without lesions? One finds lesions in general paralysis
which is ranged with insanity and we find some also in epilepsies which
are considered as neuroses; one no more finds lesions in melancholic
conditions than in conditions of obsessions. Besides, as I have often
repeated, this absence of lesions is of no importance; it is quite in
keeping with our ignorance. Every one admits that organic alterations
more or less momentary, but actually not suspected, must exist in
neuroses as in other diseases. Neuroses as well as psychoses are much
more likely to be diseases with unknown lesions than diseases without
lesions, and it is impossible to take this characteristic into account
to distinguish the ones from the others.

In reality, the notion of lunatic has lost its former superstitious
signification and it has taken no precise medical signification. That
word is now the term of the police language. It indicates only an
embarrassment felt by the police before certain persons' conduct. When
an individual shows himself to be dangerous for others, the public
administration has the habit of defending us against him by the system
of threats and punishments. As a rule, in fact, when a normal mind is in
question, threats can stop him before the execution of crime, and
punishments, when crime has been committed, can prevent him from
beginning again; that is the psychological fact which has given birth to
the idea of responsibility. But in certain disorders it becomes evident
that neither threats nor punishments have a favorable effect, for the
individual seems to have lost the phenomenon of responsibility. When an
individual shows himself to be dangerous for others or for himself, and
that he has lost his responsibility, we can no longer employ the
ordinary means of defense; we are obliged to defend ourselves against
him, a