MENTAL REACTIONS AT THE CLIMACTERIUM

In the consideration of mental illness associated with the menopause, reference is often made to involution melancholia. But this is not the only reaction of the period; any of the functional psychoses may become apparent at this time, including schizophrenia, paranoic conditions, manic-depressive psychoses, the psychoneuroses and a number of border line states. Likewise, one cannot neglect early senile and arteriosclerotic pictures. If we limit our discussion to the cases of women showing psychicsomatic symptoms ordinarily pigeon-holed in the group of involution melancholias, we do not thereby deny that analogous factors, in part at least, may be at work in the others. Involution melancholia has existed throughout the ages. It is a condition accepted as inevitable in a small percentage of people. The general practitioner is familiar with the melancholic reactions of the involution period, and often sees women with numerous neurotic manifestations, tired feelings, hot flashes, and other sensations associated with the so-called “change of life.” Problems in relation to the menopause come up daily in general practice, treatment being commonly carried out in the home. With the psychiatrist, hospital treatment becomes rather constant advice. He insists that time is essential, and especially care with regard to the possibility of suicide. But is this all we really do with such patients? Do we not by a thorough-going study of somatic and the psychic organization together, taking into account constitutional endowment, life experiences and present epochal factors, endeavor to assess the individual assets and liabilities, which in many cases so easily get out of balance at this critical period. The climacteric period, as we all know, is one through which most women pass with little difficulty. It begins as a rule between the ages of 40 and 50 and may last from one to five years. The menopause, the actual cessation of the menses, may occur early or