The subject of this paper who records her own experiences was a Miss L. S—, described as a highly gifted and well-educated lady. She was admitted to the asylum at Zürich, December 21st, 1882, being then thirty-two years of age. There was a record of insanity in her family. As a child, she was intelligent, imaginative, and impressionable, unpractical, not good at arithmetic, but fond of drawing. As she grew up, she had religious scruples and doubts, especially about the time of confirmation. She was affected by listlessness and melancholy. At her own request, she was sent to a parsonage in the Pays de Vaud, where the cloud soon passed away. When twenty-one years of age, L. S— visited Italy. Amongst her Italian studies she read the Decameron. This book did not affect or excite her at the time, but left much that was impure in her memory, which had an evil effect in later days. She never read any other books of an indelicate character. She fell in love with a man with whom she used to study, who was nine years younger than herself. Apparently they were engaged to be married. He became insane, which deeply affected her. Before her own mental derangement she had a lasting dull headache, especially at the occiput, and sometimes pains and peculiar feelings in the head, but the attack of mania came on quite suddenly. When admitted to the asylum, she was very much excited, and seems to have been put under restraint and treated with the Deckelbad (the warm bath), the head remaining uncovered through a lid. She describes her terrors, the chain of ideas which rushed through her mind. She recalls that she used many words to which she gave quite a different meaning to that they usually bear; some of them were of provincial or of foreign origin. She did not think she was insane nor recognise her excitement, and was surprised that people were afraid of her. She could, however, appreciate the mental alienation of her fellow-patients. She took great pleasure in feeding birds; she had many hallucinations and dreams which passed into her memory as illusions. She heard voices though she denied it. Her hallucinations or delusions were of various kinds and degrees, rising from mere suppositions to convictions; sometimes when spectral figures appeared to her she would guess who they were, try to identify them with real persons; for example, she saw an elderly woman of commanding aspect, very pale, and dressed in white robes, whom she supposed might be Queen Elizabeth of England. In honour of this personage she thought she saw a young horse sporting about in the sea. Looking out at the window of her cell, she saw the figure of a little grey monkey, of almost human expression, rising from the ground, and making signs for her to come away with it. This she felt willing to do, and thought that there was a kind of understanding between them. Another time, she thought that she was in purgatory, and that her companions in the asylum were going through penance there. She believed that she saw Pope Leo XIII, Dante, St. Catherine of Siena, and Francis of Assisi, and nourished the delusion that her grandmother was the original of Gretchen in Faust, and that her family were connected with Goethe. She thought that the currents of air which passed through the gratings were intended as signals from persons who wished to help her, and she stuck little things in the wire to keep up the correspondence. The birds who flew about the windows she took as messengers of freedom. She heard a tumult outside which she believed to be caused by anarchists, and a hollow voice as if preaching, but so quietly that she could not follow the words. She also heard noises like that of machinery. She thought that her teeth had been so calcified that they were all grown together, and expected them to be forcibly separated. A large number of hallucinations and delusions are tabulated in a brief form. After thirteen months' detention in the asylum she was discharged cured, and although nearly twenty years have now elapsed, she has had no return of mental derangement.
Multiple cognitive functional assessments used to modify the disturbed behavior of an elderly woman with dementia from the viewpoint of psychoeducation for the patient and her family
