Note 42 — Chapter III · Psychological Analysis and Re-education.

It should not be forgotten that when a patient in an early stage of mental disorder voluntarily seeks the doctor, his active co-operation in the task of tracing the causal factors of his trouble is of the greatest value. This assistance cannot be relied upon after the patient has been certified as insane and removed to an asylum, or even after he has been taken to the doctor at the instance of others. For obvious reasons he is then more likely to hide than to reveal his eccentricities. The simulation of insanity is comparatively rare: it is difficult and usually easily detected. It is dissimulation—the concealment of symptoms of disease—which is the doctor’s greatest enemy. The deluded man may hide his delusions because “everyone knows that these beliefs are mad:” the melancholic may pretend for the time to be cheerful in order that his liberty may not be interfered with. (Cf. K. Jasper’s Allgemeine Psychopathologie, Berlin, 1913, p. 317.) Such attitudes of the patient are obviously strengthened by our present custom of delaying the treatment of mental disorder.