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Title: Essay on the Classification of the Insane
Author: Allen, Matthew
Language: English
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INSANE***
Transcribed from the [1837] John Taylor edition by David Price, email
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ESSAY
ON
THE CLASSIFICATION OF
THE
INSANE.
BY
M. ALLEN, M.D.
MEMBER OF THE ROYAL MEDICAL SOCIETY OF EDINBURGH, AND OF THE
MEDICO-CHIRURGICAL SOCIETY OF LONDON; CORRESPONDING MEMBER OF THE
METEOROLOGICAL SOCIETY OF LONDON, AND OF THE PHRENOLOGICAL SOCIETIES
OF LONDON AND EDINBURGH; HONORARY MEMBER OF THE LITERARY
AND PHILOSOPHICAL SOCIETIES OF LEEDS, HULL, AND WAKEFIELD, &C.
* * * * *
“Thou shalt not break the bruised reed.”—_Is._
“The care of the human mind is the most noble branch of
medicine.”—_Grotius_.
* * * * *
LONDON:
JOHN TAYLOR, UPPER GOWER-STREET.
PREFACE.
IT appears necessary to explain the somewhat abrupt commencement of this
Essay on Classification. It was written, and even a great part of it
printed, as a continuation of my defence in the case of Allen _v._
Dutton; but during the progress of printing, I soon became weary of this
defensive attitude; and I also soon discovered, that so far from the
ex-parte and perfectly false statements which were reported of the trial
having any injurious influence, they rapidly expedited my success.
Thanks to the zeal and exertion of all those friends who were anxious to
counteract the effect which these falsehoods were calculated to make
against me; they spoke from personal experience, and with all the ardour
which gratitude and justice could inspire.
The design, therefore, of publishing it as a part and continuation of my
defence, was gladly abandoned. Many of the first sheets, however,
containing no improper allusion to this case, remain: I mention this,
because it accounts for that which might otherwise appear an abrupt
commencement, especially to those who have not previously read that
defence. On this account, I shall bind up that defence, (without
additional expense) at the end of this Essay, for those who may wish to
have this connexion before them. It is necessary, also, to inform the
reader of the origin of this Essay, for another reason, in order that he
may understand (and I trust, also, under such circumstances, he will
excuse) why there is so much personal minuteness in describing our system
of procedure and exertions, which could not, and would not, otherwise,
have been obtruded on the public.
But if, after being thus justified and compelled to come forth in my
defence, the matter should be found useful, either to myself or mankind,
it would be foolish affectation to seem to feel shame and regret by too
anxiously apologising and explaining the origin and consequent peculiar
complexion of this publication, or of those which may follow in regular
succession. And it is a truth, that it has increased my zeal and
strengthened my resolve to prosecute that most useful of all studies, the
study of mind,—its errors and diseases, with, I trust, so ardent a love
of the truth, that I earnestly pray I may be enabled to trace every error
to its source; for so much does the ground appear to me to be untrodden,
that I pray also, that opportunity, life, health, and encouragement may
be given me to complete the work I have to do, that, however slender my
talents may be, I may yet feel that they have not been given me
altogether in vain.
In explaining in this Essay all the plans necessary to the moral and
physical purposes of an efficient system of Classification, I have had
slightly to introduce many cases and subjects to illustrate my present
purpose; and feeling that I had not done them or myself justice, I have
said, on these occasions, I shall hereafter treat this case or subject
more amply in that part of the work in which they will be more directly
and specifically introduced.
Having thus incidently introduced many subjects without their being under
any specific head or title, I shall, to enable the reader to form some
conception of the matter, give in the contents something like a minute
dissection of the whole.
From all this, and also from what I say in my former work on Insanity, as
well as in Allen _v._ Dutton, it will be seen that I have been induced
to give pledge after pledge so repeatedly, that it becomes a serious
matter, “partaking of the nature of a solemn obligation;” if, therefore,
I fail to exert myself to redeem these pledges, I cannot have the excuse
of those who promise without even intending to perform.
In the preliminary remarks of Allen _v._ Dutton, I say at the conclusion,
“I find I must do even more than this, (meaning the defence); for my
defence would still be imperfect without a short statement of my views on
the insane. For this purpose, I propose to write the following Essays:
1st.—On Classification, and Tables in Illustration. {vi}
2nd.—The different Divisions, into which I divide the Insane.
3rd.—Their General and Specific Character.
4th.—The Correspondence between Causes and Effects.
5th.—That the Study of Mind will evolve the Principle of Universal
Generalization.
6th.—Their Moral and Medical Treatment.
7th.—A Selection of Cases in Illustration.
By this I shall be able to give a more full and perfect understanding of
the peculiar character and proper treatment of this particular case; and
by which will be seen, though imperfectly, something of those principles,
and of that spirit which has pervaded the whole of our conduct to all
those entrusted to our care.
“To do all this, in connexion with the above case, would not be right,
were I influenced by any improper spirit; but as my conviction is
confirmed by experience, that these unjust persecutions, provided we use
them rightly, are for our good, I feel in no danger of indulging in any
spirit, but a spirit of gratitude and forgiveness.”
From all this, (whatever variation I may make in the plan as I proceed)
as well as from what I say in my first work on Insanity, where the same
principle and mode of procedure is adopted, it will be seen that my task
is not a slight one. In the preface to that work, I say,
“Many subjects, not usually included in works of this kind, will be
introduced; but as my reasons for doing so will best explain
themselves in due course, and as one subject will be introductory to
another, it is unnecessary to mention them now, particularly as it
might excite critical objections, which I would rather wish to disarm
than pretend to brave.
“Without presuming on the experience, knowledge, or the materials I
may possess, of this I am confident, that so long as I am conscious
that the love of truth is my pole-star, so long will my faith
continue firm in this, that with patience and perseverance, and the
love of truth for our guide, scarcely any man’s powers are so limited
but he may hope to acquire some clearer views, or perhaps make some
discoveries in the matters he has undertaken to investigate.
“The objects of my enquiries are very numerous, and involve so many
either undiscovered or unadmitted truths, which are so closely
connected with subjects of inquiry the most interesting, that I have
adopted this slow and humble plan of proceeding for the present, and
have suspended, for a while, my first purpose of publishing a
systematic treatise on insanity.”
It is intended that each publication shall contain one subject, at least,
in some measure complete, so that each part may have its distinctive
title, and be had separately.
The study of mental philosophy, of which insanity is a very important
part, is, of all studies, provided we are on the road where truth is the
guide, the most useful to our moral state. This belief was the first
motive which induced me, now more than thirty years ago, to direct my
medical attention to this most radically-important, though
hitherto-neglected branch of the profession, as well as to whatever
seemed best calculated to make me understand the sources of all erroneous
and extreme views, and which a series of painful circumstances through
life have excited and continually strengthened; but it is not necessary
to state them: I may, however, mention that, as early as 1807, I visited
lunatic asylums _con __amoré_, and that in 1816, 1817, 1818, and 1819, I
was engaged in lecturing on Mind and its Diseases. Before this time, I
had no conception that I should ever be exclusively devoted to this
department of the profession, which _circumstances_ at that period forced
upon me. I trust, however, that I have endeavoured to profit by the
opportunities which this new situation afforded me of more fully
comprehending the nature of mind, its connection with life and
organization, its diseased manifestations, and of ascertaining the best
modes of co-operating with nature in the removal of them; and, at any
rate, it is certain that, for the purpose of lessening the miseries and
increasing the comforts of those under my care, I, for the most part,
have sacrificed every personal consideration.
From 1819 to 1824, I continued medical resident and superintendant of
York Asylum; and on leaving it, it was voted unanimously, “That I
deserved the thanks of the Governors, for my constant and successful
efforts in establishing and perfecting the mild system of treatment
there.” I was again engaged in lecturing, at the request of several
institutions, on Mind and its Diseases; soon afterwards, in 1825, I fixed
on this situation, as the best adapted of any part of the country about
London which I saw, (and I spent several weeks in the examination; nor
have I since that time seen any I like better) to carry into effect my
views of the treatment of the insane, either as respects the recovery or
the comfort of recent or confirmed cases; for here, together with
domestic comfort, diversity of occupations and amusements suited to their
various states, the retirement, pure air, and sweet scenery around,
afford ample scope for walks, without annoyance, and apparently without
restraint; which, with judicious moral and medical management, combine
many acknowledged requisites to assist the disturbed and diseased mind to
regain its tranquillity, and in many cases to resume its healthy tone of
action.
I shall only add, that all these views have been amply justified by the
beneficial results on those entrusted to my care; so much so, that these
results and my success have greatly exceeded my most sanguine
anticipations.
I here gladly close these personal remarks, which have been forced from
me, for self is a subject which it is seldom wise and always dangerous to
introduce.
It only remains to notice another peculiarity in this essay, which is,
that of having introduced some animadversions on legislators whose minds
are not sufficiently pure or comprehensive to enable them to avoid the
common error of overlooking general principles, and not to presume to
judge and draw conclusions from the hasty, partial, and erroneous views
they have acquired on the subject on which they legislate. This has
often led to, or been combined with, that great selfish view of making
themselves and their property the chief good, not considering the real
objects of legislative care, nor “that life is more than meat, and the
body more than raiment.” This it is which has corrupted all our laws,
especially our criminal code, which was a system of legal murder, not
justice, and a perfect scandal to the nation.
The same faults are visible in all they have done for the poor insane.
They have given an undue and exclusive consideration to property and to
the few extreme and violent cases; treating them and _all who have the
care of them as criminals_. To live amongst them, appears to be deemed a
crime, for which neither goodness nor talent can atone. All which must,
in various ways, have an injurious influence. To banish these errors is
to better the treatment of the insane. This conviction is my excuse for
introducing the subject, and which makes me anxious to prove, from
experience, that such extreme cases hardly have any existence at all
under a proper system of treatment; and, that at all events, this liberal
treatment materially lessens the horror and danger usually conceived to
attend these places.
Insanity is, no doubt, a terrible visitation; but why should we allow a
false and unreasonable horror to increase it? and why should we thus
sever our sympathy from a disease which more than any other requires it?
The medicinal virtues of the fruits of charity are best proved amongst
them. Grant that the disease arises from some remote or proximate
ill-directed mental states. Why should we have more horror of insanity,
than many other consequences of ill-regulated minds? To me, the foul
ward of some large public Hospital, is incomparably more horrible and
loathsome. Such direct consequences of wickedness present the object
before us in an aspect that makes it difficult for us to exercise any
feelings of commiseration towards them. Not so the insane. But these
are views, however, into the consideration of which I shall not enter in
this place; but I mention or rather hint at the diseases of other organs,
for the purpose of asserting that the reality and appearance of the
miserable state of the insane is not so shocking as people imagine; but
that still I allow it is an awful visitation.
When the gloom and horror at present thrown around establishments for the
insane shall be cleared away, Dante’s inscription over the gates of Hell,
will be no longer applicable to them,
“Lasciate ogni speranza, voi, ch’entrate;” {xiii}
this, or perhaps another passage from Euripides, has been imitated by our
Milton,
“Here hope never comes, which comes to all.”
They will be considered houses of cure, or hospitals for the insane.
The erroneous and false impressions concerning the character and state of
the insane, will be corrected. The popular impression, that they are all
violent and vociferous, destructive and dangerous, will be removed.
Hitherto medical writers, by selecting the most striking cases, have
contributed their share to this popular error. They have been led to do
this, partly because they are cases, which more naturally arrest their
own observation; but chiefly, because they are more easily described,
make a more interesting picture, and are the most curable. A statement
of the recovery of such patients, though it may serve to exalt the writer
in public estimation, is wrong in itself, and very injurious in its
influence; for it increases the unreasonable horrors and false
impressions entertained about the insane, and propagates and perpetuates
the evils of which the public and legislature complain. They receive
impressions from extreme cases, which average about five per cent. then
speak and act just as if all the insane were in a similar condition.
It would seem that these prejudices and horrors of the insane exist in a
much greater degree in this part of the kingdom than they do in
Yorkshire. There I was in the constant habit of taking convalescent
patients with me into family parties of the first respectability; and
members of these families were also in the constant habit of visiting
them as friends and acquaintances, and of inviting them to tea and to
spend the evening at their own homes; and this practice, in most
instances, had a very pleasing and beneficial influence. This was the
case with other institutions; but I have not found, neither have some
others found, any such faith in, and sympathy for, the insane in this
part of the kingdom, but quite otherwise; and yet I am certain, it is an
example they cannot too soon imitate—its beneficial influence will bring
satisfaction to themselves, will remove their prejudices, destroy their
painful fears, and lessen the chances of the calamity invading
themselves. There is a protection around those who are striving to
alleviate the distresses of others.
This difference, which I and others have experienced, makes me more
anxious “to impress these views on others, and especially on those around
me, in order that I may not be obliged, from too great a deference to the
fears and prejudices of those I most anxiously wish to conciliate, to
abridge the exercise and lessen the happy effects of a system which
theory and feeling have suggested and compelled me to pursue; and which
nearly twenty years’ experience and increased knowledge have confirmed
and justified.” {xv}
So important have I considered just views of the insane, that I have
added an Appendix for the express purpose of exhibiting a fair average of
the general appearance of the insane. With the same view, I have given a
few portraits of such of these cases as are now, either themselves, or
their friends, dead, or little known. I had the same principle in view
in my first publication, which induced me to give cases in regular
rotation, “rather,” as I there say, “than the common mode of making a
selection of extreme ones, that I might not give a distorted picture of
the insane, nor add to the unreasonable horrors and false impressions on
their state, as this has, I am convinced, been one cause of an improper
spirit and conduct towards them.”
It is scarcely necessary, after what I have already said in the Appendix,
again to guard the reader against the mistake of supposing that the cases
and treatment described in that Appendix form any data or criterion for
judging of the kind of cases and treatment in my own private
establishment. The medical swing, for instance, is stated as having been
useful, in some violent cases of mania; but this was even then soon laid
aside as objectionable; but it would be worse than useless now, because,
under a system which does not cultivate the habitual exercise of the
vindictive passions, cases in which it was of use, no longer exist. In
fact, to have recourse to any means which operates so much on the fears,
whatever medical virtues it may appear to possess, is adopting a
principal which philosophy and Christianity equally condemn. It ought
ever to be the aim of all persons IN POWER to call in no principle but
that of the OMNIPOTENCE of SYMPATHY and BENEVOLENCE; and this PRINCIPLE
is not to be excluded even from those whose spirits are imprisoned in
bodily evils and diseases.
CONTENTS.
_Page_
On the buildings, grounds, situation, and system, necessary 1
for all purposes of an efficient classification
Illustrated by an interesting case of recovery, No. 106. 5
Do. do. do. No. 195. 12
On the common division of Insanity into Mania and 15
Melancholia, not necessarily being separate classes of
cases, but generally, _merely variable states of the same
case_, requiring corresponding changes and modes of moral
treatment
This view of these cases is confirmed, and their danger 18
forewarned, by an examination of the natural constitution
of mind and previous habits of those subject to these
states
The delicate treatment which such cases often require, 25
renders a separate house, where the medical proprietor and
superintendant and family reside, of great importance, as
well for them as for milder and convalescent cases
That cases under this system, are induced, when they know 28
it from experience, or have it faithfully explained to
them, to come and return without fear or reluctance
The great importance of this first step; and of making 29
_truth the basis_. The manner of doing this explained, and
its beneficial influence stated
Illustrated by an interesting case of recovery, No. 335. 36
Ditto do. do. No. 373. 45
Further observations on such cases and the above principles 47
That suitable classification and association is better than 49
entire seclusion
Illustrated by cases, No. 425 and No. 429 51
On the beneficial influence of their being accustomed to 53
the usual habits, manners, and privileges of civilized life
On the propriety of diminishing the prejudices which exist 59
against the mere residence at an Asylum, if for the purpose
of restoration
The evils of considering diseases of the brain as a greater 61
disgrace, and as an indication of greater criminality than
other diseases
That our aim in all our moral treatment should be, to call 65
forth self-control, and all the better principles and
feelings of the human mind; and that this important subject
will be resumed
Illustrated by a case, No. 372. 69
Do. do. No. 395. 71
That often we have only a choice of evils, and must choose 73
the least
Illustrated by a case, No. 421. 75
Do. do. No. 396. 77
On the use of exercise, and a retired situation for the 78
purpose
An account of a system of cure, by being made to work, 81
related by Dr. Gregory
Regular work always useful, when willingly undertaken, but 82
not otherwise; easily managed with the labouring, but as
difficult with a higher, class of patients
The danger of irritation, illustrated by a case 83
The contrary system of soothing, illustrated by a case 84
Further remarks and quotations on this subject 86
The talents and sacrifices all this requires, and their 89
influence,
Notwithstanding all this apparent extra trouble, it is, 100
when done from right motives, the safest and easiest in the
end
That these views are based on the firm ground of Christian 108
philosophy
CONTENTS OF APPENDIX.
EXPLANATION of the object of this Appendix; which is, by 111
giving a correct description of the state and character of
a fair average number of old insane cases, to counteract
the usual misconceptions and prejudices existing against
them
Case No. 1.—His eccentricity, and exaggeration of his 113
natural character and that of his family. Has seasons of
excitement
Observation 1st.—That the fluctuations of the animal 115
spirits of the old insane often depend on causes which
equally act on the sane; but, that from differences of
state and circumstances, the effects are very different
Case No. 2.—Though in a very torpid state, yet he has (as 116
every case has) his distinguishing peculiarities
_Illustrated by a Portrait_ 116
Observation 2nd.—That mind is a garden which we must 116
cultivate—a fire which requires stirring and feeding
Case No. 3.—An example, which indeed every one is, more or 118
less, of the correspondence, as far as the remnants of mind
exist, between his present and original character and
organization. His habits of employment, and its happy
influence
_Illustrated by a Portrait_ 118
Observation 3rd.—On the use of employment, and its easy 119
application
Case No. 4.—That of an idiot. Odd displays of an increase 120
of animation
_Illustrated by a Portrait_ 120
Case No. 5.—Torpid lethargy. His natural character amiable 121
Case No. 6.—Though in a very singularly deranged state, 122
evinced by the most extravagant fancies and exploits, which
he delights to detail to every one, yet he is constantly
employed, useful, and happy
_Illustrated by a Portrait_ 122
Observation 4th.—The explanation of the peculiarity of his 124
character, proves that, in all cases, truth should never be
violated in our conduct towards them
Case No. 7.—A very singular case of periodical violence and 125
sleep. His habit of gyration described
Observation 5th.—His habit of gyration explained. How far 127
the generally alternate states of excitement and depression
of the insane is the return of their primary disease, or
for the most part, merely the habits acquired of
irregularly expending their nervous energy, which
fluctuations are further increased by the usual atmospheric
causes of excitement and depression
The influence of temperature, moisture, climate, seasons, 129
diurnal periods, atmospheric changes, and different years,
on our health and spirits, and the type of our diseases,
(and that this subject will be resumed), and how all this
is modified by the states, habits, and circumstances of the
insane
Why they are less subject to the prevailing diseases 133
The mental condition must, in all diseases, be considered 134
Illustrated by cases 135
How the state of mind and circumstances of the insane must 136
modify these physical influences
Why this is differently exhibited by the insane, than it is 137
by those who retain the power over their own spirits
That this view is proved to be correct, by the fact that 139
these causes produce different effects by their being under
different modes of treatment
That the various character of insanity is but the same 143
excitement of the vital energies operating on different
parts of the mind, according to previous or present habits
and states
Hence, the insane are often caracatures of their own, as 146
well as of family habits and character
The truth of this reasoning proved by the fact, that the 147
greatest number of insane cases occur when mental conflicts
and worldly struggles are greatest, and among those whose
minds are ill regulated or miserably circumstanced; but
still it does not necessarily and always follow that those
whose minds are most wicked are soonest overthrown, but
sometimes the reverse
The practical object of these observations 150
Case No. 8.—One of the extreme cases of furious mania, with 151
a leprous eruption of the skin
Observation 6th.—Whether cutaneous disorders are common to 153
the insane? The treatment of this case
Case No. 9.—One proof, out of many, which proves, that the 154
last strongest impression of their sane state continues
prominent, even when their minds seem for ever lost to
themselves and all passing objects around them
Case No. 10.—In which an injury on the head produced 155
symptoms in correspondence with the phrenological office of
the part injured
Case No. 11.—Apparently perfect dementia, and yet he is 156
always employed
Observation 7th.—An excellent illustration that there is 157
scarcely any insane person’s mind so much lost, but that
still, provided labour has been their early common habit,
they may with ease be brought into habits of useful
employment, and which with such a class, should, both for
their cure and comfort, be adopted, and arrangements made
for the purpose
Case No. 12.—A female instance of scolding and kindness by 158
turns
Case No. 13.—Constantly talking to imaginary objects, but 159
still perseveres in his habits of usefulness
Case No. 14.—A beautiful exhibition of female kindness and 159
love of children, as well as of many other symptoms which
indicate that her former habits and general natural
character and disposition have been amiable
_Illustrated by a Portrait_ 159
Case No. 15.—Like a passionate and proud man in a constant 161
state of inebriation
Observation 8th.—A striking instance of the correspondence 162
between cause and effect
Case No. 16.—Vanity turned into stone 163
_Illustrated by a Portrait_ 116
Case No. 17.—An unmarried female, useful as a laundress, 163
and distinguished by her affection for cats and kittens
Case No. 18.—An extreme instance of the most furious 164
excitement of the vindictive and destructive passions, and
the habits and states to which his treatment had reduced
him
Observation 9th.—The mistake of calling those facts, which 166
are the effects of improper treatment, symptoms of insanity
Case No. 19.—Constantly like one muttering in his dreams. 167
Very good-natured
Observation 10th.—Perhaps his reason might have been 168
re-awakened by constant judicious treatment and attention
Case No. 20.—An ideot, but employed 168
_Illustrated by a Portrait_ 168
Case No. 21.—Was formerly in states of furious revenge, now 169
gradually diminished in frequency and degree, by kindness
Observation 9th.—A happy illustration of the effects of 170
kindness
Case No. 22.—Mind a perfect wreck—the effect of 170
disappointed love
Case No. 23.—A very interesting caricature of political 171
mania of a person of family and title. He fancies himself
constantly employed in making calculations and in doing
many strange acts, all necessary parts of _his mighty_ task
of paying the national debt, which abstracts him from all
external objects, and from all consciousness to his own
bodily sensations
Observation 12th.—That the correspondence between the 175
present and previous habits of mind, are, in most cases,
and certainly in this, most striking
On the effects of heat and cold, and the changes of 175
temperature in the insane
That we are not to mistake, which is often done, the mind, 175
in a state of abstraction, being insensible to the external
changes of temperature, for the physical system being
unaffected by their action
That the changes and unequal diffusion of heat correspond 176
with the general and particular state of the mind, and that
in cases of pure intellectual abstraction, and in those
excited by the bad passions, it is very different, and in
cases of gradual decay of mind, it is altogether defective
To discriminate those differences is necessary to regulate 179
our treatment according to the exigencies of the case
Observation 13th.—On the effects of intense study and 180
general intemperance of the mind
That when study is blamed, I have often found that the 180
intemperate feelings, wicked and irregular habits, were the
real causes
That proper mental exercise is as essential to the health 181
as bodily exercise
That it is a great error to suppose such exercise injurious 182
or discountenanced by religion, provided always the mind is
under the influence of right motives
Case No. 25.—A dignified exhibition of all the mental 190
energies arranging and concentrating themselves under his
self esteem
_Illustrated by a Portrait_ 190
Case No. 26.—A caricature of a masculine female 193
Case No. 27.—One of extreme torpor and debility 193
Observation 14th.—That the character of all hereditary 194
cases retains something of a family resemblance
Case No. 28.—A caricature of Johanna Southcott’s followers 195
_Illustrated by a Portrait_ 195
Case No. 29.—A most horrible object of demoniacal violence 197
suspended twice by a physical accident and disease
Observation 18th. {26}—On the doctrine of demons, and that 198
the subject will be resumed in an after part of this work
Case No. 30.—A very interesting demonstration of the misery 199
of ill-assorted marriages, and that the painful and
powerful association of the original cause of the disease
produced its frequent recurrence
Observation 19th.—On the evils of such marriages, and that 202
the consideration of this important subject will be resumed
in an after part of this work
Case No. 31.—A singular and most interesting case of an 203
active, excitable, and overworked mind being overthrown by
family afflictions, his power of personating various
celebrated characters of different periods of the world,
which he believes himself for the while to be. His
splendid eloquence and conversations with imaginary beings,
&c. Still, there were encouraging symptoms, that by proper
and laborious methods of mental occupation, he might
possibly have had the balance of his mind restored
_Illustrated by a Portrait_ 203
General explanation of the peculiar complexion of this 207
work, and of the Appendix in particular
Concluding observations, that the object of this Essay, and 209
especially of the Appendix, has been to lessen the
prejudices against and better the treatment of, the insane
* * * * *
LIST OF DR. ALLEN’S PUBLICATIONS.
CASES OF INSANITY, with Medical, Moral, and Philosophical Observations
and Essays upon them. 1 vol. 8vo. price 8s.
“Thou shalt not break the bruised reed.”—_Isaiah_.
“The care of the _human mind_ is the most noble branch of
Medicine,”—_Grutius_.
_Extracts from the Reviews_.
“We consider Dr. Allen’s Work one of great interest.”—_London Medical
Journal_.
“Dr. Allen’s work is well worthy the attention, not only of the
Faculty, but of all persons who have relatives or friends afflicted
with that fearful malady.”—_Periodical Review_.
“Strong, perspicuous, and concise; this work is deserving the highest
estimation.”—_Periodical Review_.
“Our limits prevent our doing such justice as we could wish to this
very able book.”—_Union Monthly Magazine_.
LECTURES on the _Temper and Spirit of the Christian Religion_; on the
_Preliminary Principles of Early Education_; on _Christian Forbearance_.
Written for the use of Families, Schools, and _other Institutions_.—Price
10_s._
_Extract from the Reviews_.
“We hope this excellent book will find its way, not only into the
hands of all heads of families, but also into the hands of all
persons engaged in the education of youth. The tendency of the
discourses is elevating and good; they are evidently written from a
heart warm in the cause of humanity, Christian toleration, and for
the improvement of the human mind.”—_Monthly Magazine_.
OUTLINES OF A COURSE OF LECTURES ON CHEMICAL PHILOSOPHY. Price 5_s._
_Extracts from the Reviews_.
“A Series of Essays, rich in ingenuity of argument, and abounding in
masterly views on the great subject of Chemical Agency, as effecting
changes in the modes of existence of physical matter: the whole
enquiry is conducted with much philosophical acumen.”—_London Medical
Repository_.
MEDICAL, MORAL, AND PHILOSOPHICAL ESSAYS AND OBSERVATIONS UPON INSANITY.
ESSAY ON CLASSIFICATION, Illustrated by Cases.
ALLEN _versus_ DUTTON, consisting of Preliminary Remarks: Affidavits in
Reply, and Affidavits in General; and General History of Mrs. Dutton’s
Case, as they appeared on this trial.—Price 3_s._
“A series of Facts very material to all having care of the Insane.”
* * * * *
The above Works may be had of JOHN TAYLOR, Upper Gower-street; or through
the medium of any country bookseller.
* * * * *
_Also_, _by the same Author_.
OUTLINES OF A
COURSE OF LECTURES ON CHEMICAL PHILOSOPHY.
ESSAYS OX CHEMICAL PHILOSOPHY.
IN the Annual Review of Medicine and Collateral Science for 1818, of the
London Medical Repository, the following notice is taken of these
Essays.—
“In the Philosophical Magazine the reader will find a series of
Essays by Mr. Allen; rich in ingenuity of argument, and abounding in
masterly views on the great subject of chemical agency, as affecting
changes in the modes of existing of physical matter. These essays
all go upon the principle, that in every change of existence that
matter is capable of undergoing, caloric is given out or absorbed in
the form of either electricity, of galvanism, of caloric, or of
light. Respecting the important question which has recently agitated
the philosophical world, and which has been proposed as a prize in
one of the Societies abroad; viz. In what does the difference consist
between galvanism and electricity? Mr. Allen observes, ‘In
electricity we contrive, by mechanical means, to collect the loose
and uncombined quantity from the earth and surrounding medium; and
this we do in circumstances in which it has nothing to act upon, as
free from moisture of any kind as possible; in fact, from every thing
readily soluble in heat or in this power. I would therefore, he
says, define electricity to be the object of science which treats of
the mechanical and natural means of separating this _grand agent_
from some of its combinations, and of ascertaining its actions in
this state.’ ‘In galvanism, on the other hand, this solvent power,
this electric fire, is produced in circumstances in which it has
_substances_ to act upon; substances which are most readily dissolved
in it; substances, in fact, which seem to form the grand medium
between this _power and passive substances_, and which are partially
dissolved in it. And hence I define galvanism as the electric fire,
or _grand agent_, only _partially_ separated from its combinations;
by which I refer principally to oxygen and hydrogen.’ After
illustrating this principle, by referring to the circumstances in
which the chemical agency of galvanism appears more conspicuous than
that of electricity, he adds, ‘thus we perceive, that when _the grand
agent of nature_ is _more perfectly_ separated from its combinations
it is ELECTRICITY; when partially separated, GALVANISM.’ Of these
views and principles we have a more ample illustration and defence as
the author proceeds in his investigation; and the whole inquiry is
conducted with much philosophical acumen. Hypothetical, of course,
part of it must be: but how different are the hypotheses of the
present from those of former times, when science was a sort of
poetry, and dealt in abstractions and inventions!”
* * * * *
ESSAY
ON CLASSIFICATION.
THE better to explain and illustrate my ideas and views on the important
subject of Classification, I shall, in the first instance, give a brief
description of the present plans, arrangement, and manner of proceeding,
in my own establishment.
Fair Mead House, Leopard’s Hill Lodge, and Springfield, with appendages
to each, constitute my present establishment at High Beach; and I wish to
have it most distinctly and most fully understood, that they are simply
for classification, of a more general or more specific nature; and
consequently, besides the advantages derived from having three houses, I
have (as far as I could) made arrangements in each for this purpose.
Leopard’s Hill Lodge, where I have more especially made arrangements for
the purpose of classification, consists of a front, or what may be called
the family portion of the house, and galleries behind, with appropriate
rooms for patients requiring more restraint.
To show that these houses are merely for the purposes of classification,
I may mention, that there is no sort of difference in the three houses,
excepting that in the one generally and latterly inhabited by ourselves,
we prefer having those to whom our individual and more immediate
attention may be useful. The same patients are even sometimes at one
house, and sometimes at another, according to their state; and sometimes
for the mere purpose of change. In fact, the greater part of our first
class of patients have been occasionally at Leopard’s Hill, and this with
the knowledge and approval of their friends.
As I have published some hints on this point, and addressed them to the
Commissioners in Lunacy, I may be permitted, in order to show I have long
entertained the same views, to quote two or three passages.
I there state, “that two establishments on the same grounds should be
allowed and encouraged for the purpose of Classification. My reason for
this alteration, in the Act relative to such places, is, that large and
crowded houses are decidedly objectionable, from the greater chance of
noise and disturbance, from their being less healthy, and from their
assuming more of a prison-like appearance, than of a family mansion.
With two, we can adopt a better and more complete method of
classification; and it is a consideration of very great importance, that
in one of them the proprietor and his family should reside, and devote
themselves to recent, partial, slight, or convalescent cases.”
As I conceive this plan of two establishments for the purposes of
classification, to be of the highest importance, and essential to the
moral regulation, as well as to the cure of the insane, so far from
avoiding any investigation of either the principle of their adoption, or
their mode of management, I wish the most exact knowledge to be obtained
of the one, and invite the fullest scrutiny of the other.
I would have not only two establishments in the same grounds, but these
sufficiently separated so as to prevent annoyance; and, not only this
separation, but I would have one to consist of a male and female part,
sufficiently separated from each other. This arrangement I have at my
own establishments, which consist of Fair Mead House, and of Leopard’s
Hill Lodge, for males, and Springfield for females, with appendages, and
separate cottages; and more especially, I would have each house divided
into a front and back part, and this front part so contrived, that in
appearance it should be sufficiently distinct from the other, so that
patients might feel, on recovery, that removal to this part withdrew them
from the more painful associations of their past state, and afforded them
solace and encouragement; thus might their recovery be expedited, and the
chances of relapse lessened. In the domestic part of the establishment,
the proprietor and his family should reside.
In many cases, an entirely separate house is required. I have known
cases, the cure of which would have been apparently blighted and blasted
for ever, if they could not have been wholly removed from, not merely the
real, but the apparent, association of former scenes and circumstances,
and this without any change in their servants and medical treatment and
attendance, which is also essential. Yet it is perfectly true, that in
other cases this association is not so injurious as most people would
imagine; the dawnings of the light of the understanding are, for the most
part, so gradual, and the mists of delusion so gently steal away, that
there would be a greater shock given by a sudden transfer to rational
scenes and real life, than by their continuance in the place where they
might be at the time.
I have often, with feelings of wonder and admiration, had occasion to
observe these occurrences. I have seen a convalescent patient very much
attracted by, and perfectly delighted with, the strange remarks,
speeches, and conduct of another inmate, sometimes fancying it was meant
purposely for his amusement and diversion; and on whom, refined wit would
have been lost, while the incongruous combinations of unguided thought,
which no wit or ingenuity can equal, appears, and is the very essence of
wit to him. Notwithstanding the truth of all this, there are other
cases,—cases of more sudden convalescence, where all this would shock and
horrify, and produce a revulsion of feeling, most dangerous to them in
their delicate and fragile state, and perhaps permanently fatal to their
recovery. This is more particularly the danger in the incipient stage of
convalescence in some violent cases of mania, {5} and where I am quite
certain delicate and judicious attention have been essential; and where
first, perhaps, removal to the family part of the house, then removal
altogether to our own house, was apparently their salvation.
_No._ 106, _admitted April_ 11_th_, 1820, _aged_ 65.
This was one of the cases apparently saved by such timely attention, and
which I intend hereafter to describe more particularly, for the purpose
of illustrating both the medical and moral treatment of many similar
cases of insanity. I shall, however, state so much of the case now, as
will be sufficient to show, that there is not only a critical period of
the disease, when judicious medical and intellectual attention arrests
and prevents its transition into another and equally dangerous form of
over-excitation, so dangerous, that if allowed to take its course, it not
unfrequently ends in dementia, but also, and more especially to show,
that in all cases our moral treatment must have in view the nature of the
existing causes, in order that we may be able to adopt the most suitable
methods of counteracting their effects,—a part of treatment which has
hitherto been either wholly overlooked, or else exercised without much
knowledge and discretion; although I am certain it is of great importance
in the treatment of all curable cases of insanity, and in many cases so
important, that by such methods we may ultimately succeed in removing
these causes altogether; and removing them, remove also the fear of their
again (at any future time) being allowed to have any baneful operation.
This person, who was a dissenting minister, had always been reckoned by
all parties, one who entertained gloomy views in religion, and pushed
these into extremes; his zeal was equally violent and vindictive, and he
besides possessed a mind with every opposite quality in excess, and which
had always, as far as I could ascertain, been in a state of irregular and
discordant excitation; it is quite certain that during many years past,
it had been habitually kept in a very painful and irritable state, by
several causes, and one more especially deserving notice. He lived
unhappily with his wife and her friends,—instead of union and harmony,
all was dislike and contradiction, perpetual storms and altercations,
which had just before terminated in a separation between himself and
them.
Thus, from the condition of his own unsettled and ill-constituted mind,
his gloomy and vindictive views in religion, his variable and irritable
temper, and from the nature of the domestic excitement under which he had
suffered most severely, it was easy to trace the distressing and awful
form of his derangement to the causes which had produced it.
He was in a state of the most furious mania;—his was one of the most
violent and distressing cases I had ever seen. It is impossible to
convey any adequate conception of its appalling nature. His language was
obscene and vulgar, and his horrible oaths and blasphemous speeches were
poured forth for some weeks without ceasing, and without sleep, with a
volubility, rapidity, and a voice so loud, and so foaming with passion,
and with such a frightful expression of countenance, that even those most
accustomed to such scenes, and of the strongest nerves, trembled before
him. He had a demoniac energy and eloquence, which was, indeed, of the
most harrowing and awful kind. It was truly terrific! for even at a
distance, his voice sounded like a river escaping from some narrowed
part, and rushing with impetuosity over every thing that would impede its
course.
Had a short-hand writer taken down his ravings, it would have proved that
this picture is far from being an overcharged one. One principle subject
of his furious raving, was his favourite doctrine of Election; or rather,
perhaps, I ought to say, his blasphemous doctrine of Reprobation. He was
constantly denouncing every one (and against myself he was peculiarly
severe) as lost, whose belief on this point was not, even in phraseology,
the same as his own;—calling on God to execute vengeance upon them;—then
blaspheming God, that his prayers and commands were neither heard nor
obeyed;—taunting and cursing Him with a contempt which no language can
describe;—calling his clemency weakness, and his not executing his
decrees a proof he did not possess the power he pretended to have. In
fact no one could hear and see him without feeling shocked, and without
having a conviction forced upon him that there must be something
wrong—some perversion of truth in those doctrines, as well as in his own
mental system, out of which all this dreadful spirit, and all these
terrific extremes originated, and of which this case appeared a Satanic
caricature. It is a truth, that there is no error or perversion of truth
that we may not perceive in reviewing the history of mind caricatured,
and perhaps in a still more striking manner among those who are in
confinement from being _directly_ denounced insane.
On the subsidence of his excitement, he was overwhelmed with the perfect
recollection of all he had uttered during the utmost fury of his dreadful
ravings, and his state was truly miserable and deplorable. In this state
I took great pains with him, treated him with every possible kindness,
and endeavoured to show him every possible mark of my confidence: one
instance of which may be mentioned.—I gave him, at a very early period of
his convalescence, a set of manuscript sermons, all in loose slips, and
which he read with great pleasure, and preserved with great care. They
were affectionate moral discourses, strictly, I believe, in agreement
with the spirit of Christianity, though not on any peculiar doctrines;
for in these I had purposely avoided all doctrinal points, although
doctrinal views may, when properly presented, be the best preventives,
and in some cases the best medicines, in the cure of insanity; but the
circumstances in which I was at that time placed, appeared to forbid even
their most cautious introduction, and were scarcely admissible to an
audience consisting of some of almost all denominations. However, he
said, the spirit of these discourses just suited his altered state of
mind, for he himself felt horror-struck at the views which had led to
such awful consequences.
Though no one can feel more than I do, the necessity of not busily trying
to proselyte or unhinge unnecessarily any one’s settled opinions, yet
this was an extreme case, and in such cases, where cure seems to depend
on the proper administration of counteractive views, every other feeling
should give way to this conviction; but at the same time, every thing
depends on the judicious mode of stating these sounder views. This case
was a remarkable instance of the necessity of such management; and where
such views were apparently of the utmost importance to his comfort and
peace. But it would require a separate Essay to defend what I conceive
those sounder views; and even were I to give this striking case as a
specimen of their happy influence, I still might lay myself open to
cavils and objections. I shall, therefore, in a separate Essay, bring
forth all the arguments, and exert all the power I possess in their
defence.
Though his furious state was so unusually violent, yet it was of long
duration, and after it had left him, it was some time before he was able
to overcome the painful reflections which came over him; he however
recovered, and returned home in the September following, since which
period I have received many, and almost constant proofs of his great
gratitude and attachment to me, one of which is worthy of being stated.
In the autumn of 1824, he walked about a hundred miles to see me, and not
finding my place of residence, he called on a medical acquaintance, to
whom his description of my kindness and attention, and their happy
influence upon himself, were so powerful and eloquent, that this new and
accidental medical acquaintance, became from that time to the present, my
first and warmest medical friend in encouraging me to establish myself in
my present residence, and to whom I have to attribute the origin of all
my success; so that this recovered patient’s gratitude, who followed me
unexpectedly, was the first step in my progress, and was the _sole_
foundation of every thing which I have done or exists in this place. It
was my only introduction. I may be permitted, therefore, to acknowledge
my great obligations to the warm-heart friendship of the person, of whose
melancholy state I have just given a general description, as well as, the
medical friend to whom I have alluded.
_No._ 195, _admitted October_ 27_th_, 1821.
This case, I shall hereafter show, was apparently saved by this
separation from former associates, at this critical period of
convalescence, and he was one who required very superior and intellectual
attention.
He was a young man of some talents, and of various pursuits and
acquirements, by far too many to be perfect in any one. Born with a
large proportion of the family failing, his vanity had been fed by
flattery and example, so much so, that it might be said he was bred in
vanity’s hot-house; and ultimately, from over excitation, and too little
collision with the world, he fancied himself a second Crichton. Of
course with such an estimate of himself, it could not be otherwise but
that he was constantly meeting with disappointments and mortifications,
on his entrance into his profession, and the real business of life. From
these causes, as well as from an increase at this time, of parental
embarrassments and mortifications, (and home had always been an
atmosphere of perpetual storms), from an hereditary scrofulous habit, and
from his self-made morbid state, his mind was at last overwhelmed. But
it is not my intention to enter into all the details of his history,
further than to prove that the causes which produced his disease, and the
form his insanity assumed, perfectly corresponded with each other.
On his arrival he was in a very exalted state of over-excitation; he was
the greatest of men in every mental capacity and acquirement; all
Philosophers, Poets, Painters, and Linguists, that had been, or were in
existence, were nothing in comparison with himself, nor were their works
to be compared with those he intended to execute, and the basis of which
he had already formed in his own conception. Nothing could exceed the
vain and pompous displays of his talents and acquirements; and it is
impossible to conceive, from the difficulty he had to support his
pretensions, with the defects under which he then laboured, what a very
painful and ridiculous exhibition it produced. Still his vanity and
exaggerated estimate of himself, combined with his ineffable contempt for
others, remained unchecked. One feature was very striking; he possessed
considerable powers of imitation, in the exercise of which he took great
delight, and in pouring forth his contempt against others, he did it with
the attitude and voice of Kemble; it was almost impossible not to feel
the force of his manner, and against myself he was particularly severe,
and his poignant expressions of contempt and indignity were most
provoking and overwhelming. When, however, a change of state occurred, I
felt so interested for his trembling and doubtful situation, that I had
even a bed put up for him in my own room. I had always some case of this
kind about me, and no one can conceive the sacrifice of health and
comfort it cost me.
This case, as well as the last described, may perhaps be detailed more
particularly in their proper place, to illustrate a general principle, of
far more importance than even moral treatment. And even in moral
treatment it will appear how important this general principle is, to
enable us to perceive how we may best counteract the effects which may
have arisen from the operation of baneful causes: for by it we shall be
able to trace errors to their source, and without this, we can never
counteract and cure them. And this we can only do with certainty, by
possessing correct views of the origin, nature, and constitution of the
human mind, and of the correspondence which exists between physical
effects, and mental or spiritual causes: out of which views this general
principle will be educed, and it will be found to be of universal
application.
In this case it is evident, a system of moral and intellectual treatment
was required, in order to counteract and cure the effects which had
arisen out of the soil in which he had existed, very different from that
which was necessary for the previous case; and it is equally evident,
without such knowledge, it is more than probable that neither of these
minds would ever have been restored to their balance, or right state.
He recovered, and his character appeared much improved by his severe
visitation. He became very much attached to me, and wrote a great deal
for me, as my amanuensis. It is worthy of remark, that he remained of
choice for a considerable time after his health was re-established, on
account of the dread he felt at returning to the place and circumstances
where his disease had arisen.
It is remarkable also, that after he had been some weeks in private
lodgings, assisting his father, in his profession at the Assizes, he, the
very night previous to their intended return home, made his escape to
America.
It is singular, that the first case I had, as an insane patient, after I
left York, was his sister.
I might select a great number of cases, where I conceive such attention
was apparently one principal cause of their recovery, and which I took
under my more immediate care on this account, and to whom I devoted much
of my time, and made many sacrifices of my comfort and convenience.
In order to show the importance of such attention, it will be necessary
briefly to explain the description and character of the cases to which I
more particularly allude, and that it may appear that these opinions are
not new, I shall quote from the first part of this volume already
published. I there say, “What is called mania and melancholia, are for
the most part effects of the same power being overactive, but overactive
in different directions.” If the distressing passions are overactive, we
have melancholia,—if the animal propensities, we have furious mania,—and
if the exhilirating passions, we have an exuberance of joyous activity.
“This is a view not before taken, and will account for much of the
difference in the effect from the same cause. This melancholy, or state
of depression, caused by the activity of the depressing passions, is to
be distinguished from the state of exhaustion and debility, which
succeeds some violent paroxysms, or which follows an exhausted state of
body and mind from overexertion, and assumes either an apparent
melancholy character, from torpor or partial suspension of mind, or is in
reality a case of melancholia of the most miserable description, from the
exclusive activity of these depressing passions, which are then more
likely to become the sole masters of the field of action.” {16}
In the former mentioned cases, it appears, that the exciting and
depressing passions alternately take on habitudes of action, so that it
is still over excitement, but the effects, from its direction being
different, are diametrically opposed to each other: in the one case, as I
have already said, this nervous energy is employed in exciting into
activity the passions which exhilirate: in the other, those which depress
us.
This excitement of the depressing and exhilarating passions alternately,
is the most striking characteristic of the insane. It is true, that both
these states or stages of the disease, if long continued and not well
managed, are necessarily followed by a third state of exhaustion. The
systems of body and mind are wholly worn out by exertion, and require
rest to recruit and manifest their renewed power, but changes from one
state to another is only a partial exhaustion; another class of feelings
become active, while the former are suspended, so that the melancholy and
“high state” are for the most part, states of mind or changes in the
direction of its energies, and not that the melancholy have less than the
furiously malignant or joyous maniac, of that power which is equally
necessary to mental activity of every description.
For instance, I have known the same person sent at one time as patient
under the influence of religious melancholy, originating in erroneous
extreme Calvinistic views; and at another period in the most joyous state
of religious excitement, from having come under the influence of extreme
Arminian views. On the same principle, I have by the most laborious
process of argumentation and the statement of what I conceive right
views, produced a counter-impression, given another character and form to
the disease, and in some cases, on this principle, effected a cure. {18}
As these cases are much more common, and these views of much more
importance than mankind, or even medical men imagine; and as many who
possess a susceptible constitution of mind, similar to those whose cases
I have described, are living in the world in this fearful and continual
state of mental excitation, and of course, may be on the verge of the
same precipice, it is right they should be warned of the danger to which
they expose themselves.
It need scarcely be mentioned, that the present constitution of society
is not in a healthy state. It is not bound together by that order and
sympathy which should exist, but on the contrary, discord and
disseverment prevail to an extent which seem to threaten its
decomposition and destruction. But too many individuals are intoxicated
with the fury of their various passions and inordinate desires, and mad
with the endless anxieties and reverses they produce. One part of
society, as well as one part of the mind, is at war with another. I wish
it, however, to be particularly observed, because I shall have to revert
to the fact hereafter, that it is not so much these exciting causes, or
even the sad effects of these feverish and wasting passions, that are in
themselves so dreadful and fatal, as they are when accompanied or
followed by the conflicts and condemnations of conscience. Wherever
there is the endeavour to overturn and sacrifice some confirmed and good
principle, that which is lowest is encouraged to struggle for
pre-eminence, and the mind suffers extreme misery and distraction.
It is in this way that we often find minds that have much that is amiable
about them, are soonest overthrown; but in all cases when (as in this and
what is in fatality next to this, perpetual domestic discord) _the fire
of our spirits_, which should give life, health, and support to our
exertions, is not united and clothed with that wisdom which ought to
diffuse itself in every useful direction; it is in an altered and
dangerous state, producing, according to this alteration of state,
disordered function, _acrid secretions_, and if long continued, disease;
and when disease is established, its state is further altered, so as
literally to “eat up the flesh,” and in one form or another burns,
scathes, withers, and consumes us, {20} but I need not now enter into all
the various evils, miseries, and conflicts in which the mind is involved,
and the dangers to which it is exposed, nor the corresponding physical
effects, nor show that even were these extremes exclusive and improper,
activity does not exist, but where the understanding seems most
completely called forth; still we have reason to fear that we pursue the
important duties of civil life, whether it be the weighty matters of
legislation, or the scarcely less responsible exercise of the learned
professions, or what ought to be the binding and sweet influence of
faithful dealings in trade, and our common intercourse with each other,
in an improper spirit, and from improper motives, and not with that
singleness and simplicity of heart for each other’s good, which alone is
useful and safe; which we could not fail to do, were we sufficiently
aware, that in as far as we depart from this purity of spirit, our views
of truth must be perverted, _and our __healthy vital energies changed_,
_causing fever_, _paralysis_, _or some morbid state_, and all our
sympathies poisoned and deranged. But I might find enough of matter for
illustration without detailing the effects of over-excitation, arising
from our mad desires after wealth, fame, and distinction, or even the
consequent distracting and overwhelming miseries of misfortune, poverty,
and starvation, in the modes and amusements of fashionable life, to which
sensitive persons, and especially those who have made themselves morbidly
sensitive, become, as in the case last stated, the victims.
Excitable and cheerful persons often fall into states of depression,
purely because they have drawn too largely and exclusively on their
exhilirating passions; whereas, had they drawn equally on the depressing
passions, they would have tempered and balanced each other, and kept the
mind in its right state; and such is the constitution of the world we
live in, that our duties require that both should have their relative and
appropriate share of exercise.
Persons, often, in company, think it necessary exclusively to exercise
the exhilirating passions, and they return home not only with these
feelings exhausted, but with the depression passions assuming in their
turn an over-active state, and in this state they perhaps encourage a
spirit of discontent, and peevishness, making sad havoc of domestic
peace, and producing an unhealthy state of mind, _an alteration in the
state of the nervous energy_, _generating an acrid and morbific matter in
the system_, _and ultimately disease_, both in themselves and others.
{22}
It is too well known that many who are all life and energy in company,
sink on returning home, into this state of apathetic melancholy. This is
especially the case with those persons who are betrayed by their buoyant
spirits and powers of pleasing into extremes, exciting themselves by
stimulus and other excesses; and as they are often minds originally of
the most amiable constitution, they afterwards, when left to sober
reflection, are overwhelmed with self-condemnation; and should they, to
raise their sinking spirits, have again recourse to stimulus, the evil is
increased, and the effects are terrific. It is to these painful and
conscientious conflicts, as much, and perhaps more, than the mere
physical effect of their excess, that the disorder and destruction of
their minds are to be attributed.
I mention these simple and common forms of irregular and discordant
excitation, to shew that from such causes the susceptible mind gets into
the habit which may terminate in the more fixed and serious form of
alternate states of irresistible excitement of the exhilirating and
depressing passions, constituting insane cases, just as we find those of
the alternate over-excitement of the kindly and benevolent affections;
or, of the angry and malevolent passions terminate in corresponding
states.
How many persons live in this baneful domestic atmosphere of perpetual
storm and sunshine? And hence, when the mind of one of these becomes
morbid, and the malevolent passions assume the exclusive sway, they are
said to hate those they formerly loved, which is simply the more
permanent state of their former fits of anger; in fact, every form of
incipient insanity may be traced with more or less ease, to these
corresponding causes. This may not be popular doctrine, but it is the
truth.
Many married persons get into this destructive habit of indulging in
these extremes of anger and affection; and where they are known to have
existed in no common measure, they propagate this their state of mind in
their children, and which is afterwards most effectually and successfully
educated by their conduct and example; and hence such domestic circles
are fruitful soils in producing insane cases. I could state some fearful
examples of the truth of these observations, but I would gladly throw a
veil over these melancholy pictures of human nature. The sword may slay
its thousands, but the demon of domestic strife is much more destructive
to man’s life, health, and peace.
I mention all these matters, to show that such are exactly, in their
incipient form, the cases which require the most delicate, intellectual,
and laborious attention. The delusions which occur in an after stage,
arise out of these habits, and until they appear without disguise, it is
difficult for strangers to pronounce them insane; and yet these are
causes which produce the worst and most incurable consequences; and if
cure is to be effected, it can only be by a system of management, which
by calming and tranquillising the mind, will best allow the physical
effects to subside. But when this painful and irritable state of mind
has been of long duration, and some chronic and inflammatory state of
insiduous, slow, and gradual growth, is the consequence; then a longer
time will be required before cure can be brought about. I may here
remark, that it is absurd to suppose we can expect this, by moral or
medical means singly,—they must always co-operate, and never be separated
in the mind of him whose object is cure: and it is a most important and
fearful consideration, that on their treatment depends the increase or
diminution of their disease.
To show there is the greatest difficulty, delicacy, and anxiety required
to be exercised in the management of these cases, it is only necessary to
mention, that they are precisely those, who, as I have already said,
though they are either in reality, or ultimately prove the worst and most
dangerous cases, can nevertheless, in the incipient stage of the disease,
and more especially immediately after being placed under moral restraint
and medical care, exert their remaining power of self-control over their
delusions and extravagances, so as to appear, for some considerable time,
perfectly sane. Indeed, it may be considered as a general fact, that
where the insane person preserves his individuality of character, and his
alarming state is chiefly indicated by his having his prominent
peculiarities in the natural constitution of his mind in a highly
exaggerated and caricatured state, (which is always a most unfavourable
prognostic, and more particularly if this exaggeration be grounded in
self-love,) the incipient stage assumes this delusive appearance.
It is to such cases, in their incipient stage, that I have hitherto
devoted myself, and which I have had for the last fourteen years
constantly about me.
In devoting ourselves to such cases, we are doing no more than we
conceive to be our duty, nor do I conceive this explanation makes, in all
cases, our own house superior to others. In some cases, the reverse is
the fact. This explanation is intended to show the necessity of
classification, and division of labour. In many cases, so far from
giving a preference to ourselves, I would give a preference to the
surgeon, matron, and attendants at the other houses. In many cases, they
become attached to them, and prefer remaining with them. Besides, a mere
change is sometimes useful, and often operates as a powerful check;—they
are in their favourite house,—they behave ill, and a threat of removal
restrains them. All this requires attention, and is assisted by the
arrangements described.
To show this is no new and fallacious view, manufactured and brought
forward for the mere purpose of my own defence, I beg leave to quote from
an explanation of the drawings and plans of the houses and grounds, which
were, according to the Act of Parliament, sent to the Quarter Sessions at
Chelmsford, now many years ago.—Speaking of Leopard’s Hill establishment,
I said—
“At present there are no very violent cases, and some that were so
are convalescent, and when patients become convalescent, they are
often removed to my own house at Fair Mead, in order to relieve them
from painful associations; by contributing in every way to their
comfort and their happiness, and by devoting ourselves more
particularly to them, we secure and expedite their cure; this removal
is often most expedient and useful, but it sometimes happens, {27}
that they prefer remaining amongst those to whom they have become
attached; and they are then removed out of the galleries, and have
apartments in the front and family part of the house.”
“Fair Mead House, I wish it to be distinctly understood, is an
additional house in the same grounds, but at a sufficient distance to
serve the purpose I have just stated,—the purpose of humane
classification, according to their state. In fact, agreeable to
these views, it may be considered as a necessary appendage to the
others. It enables us the better to discharge a most important and
delicate duty, that of more closely watching, and more directly and
personally attending to patients during the incipient and critical
stage of convalescence; a period when, wanting such attention, they
are driven by a revulsion of feeling into their old state, or sink
from exhaustion, and die.”
“Again, by having three houses separated in this way, and for these
purposes, it not only enables us to divide the males from the
females, but also to devote ourselves to those to whom a more
delicate and intellectual attention may be useful, in this critical
period of convalescence, and it also enables us to select such,
whether old or recent cases, as are capable of participating in, and
not deranging very much the enjoyments of the domestic and social
circle. All which will include convalescents; some incipient cases;
some that are melancholy; others that are imbecile; some that may be
permanently deranged, but very full of good nature, and not
troublesome; and some that are hopeless upon some specific point, but
pretty correct on all others.”
Another consideration of greater moment is, that persons necessarily
attach an importance to the house in which we more generally reside, and
even some recent slight cases feel none of that painful repugnance in
coming to us, that is usually felt on the bare mention of a place of
confinement, {28} and many come not only without reluctance, but with
voluntary pleasure. In my tables, sent to Lord Lyndhurst three years
ago, I there show that more than one-third of the patients then received,
had been so brought, and “that I had always held forth to them the
promise that they were coming as visitors,” saying, “as long as you
behave as such, you shall be treated as such.” When they forfeit this,
they are deprived of their privileges, and, in some cases, they may be
sent to Leopard’s Hill establishment; and in others, a threat of their
being removed from this to Fair Mead, answers the same purpose.
I consider it a point of the very first importance, that truth should
never be violated; we must, therefore, on no account, at any time,
deceive them, and more especially in the first instance. If we begin by
destroying confidence, we destroy the basis on which alone all moral good
can be effected. Without truth there can be no confidence. It is quite
a mistake to suppose a system of deceit is necessary for the purpose of
more quietly accomplishing their removal from home. I can
conscientiously assert that my own experience proves the contrary, and
that I have not found in a tithe of the cases which I have had to manage,
any very great difficulty in persuading them willingly to accompany me,
more especially if I had sufficient time given me to ingratiate myself
into their good opinion and confidence, which I do, by fully explaining
the object of their removal, the treatment I intend to adopt, and the
means to be used to make them as happy as possible in the new
circumstances in which they are about to be placed. Whenever this was
done, and I found them in a state to understand it, which is the case in
a greater number of instances than most persons imagine, they have then
almost invariably been persuaded to come willingly, without using any
arts of deception.
I delicately, but candidly tell them, that they are considered to be
insane, that the disease has produced some change in their usual mode of
feeling and thinking, that the object of the proposed visit is their
good, and that if they will only go willingly along with me, I pledge
myself they shall be treated as visitors, unless their own conduct should
oblige me to act otherwise towards them. If after all the pains I take,
(and no pains can be too great to accomplish my object in this faithful
way,) they still refuse, I then tell them, that their going is a matter
quite settled, and cannot possibly be altered; that they may as well make
a merit of necessity, and like rational beings, go at once with
cheerfulness, and good-will, in order that they may still receive the
good which I have promised them.
If after such explanations they do consent to go willingly, or even
without much force, a grand point is accomplished; for in this case,
suppose after their arrival they grossly commit themselves, and justly
forfeit their claim to the treatment I have promised them, and I am
obliged to abridge them of the liberty they had really given them, they
then feel and often acknowledge the justice of any change in their
treatment, which is the result of their gross misconduct, and they exert
themselves with the hope of regaining the liberal privileges they have
forfeited, and thus from their desire to be considered and treated as
visitors, they put forth into operation what is of the greatest
importance, the valuable principle of self-control.
In most cases, while nothing is more consoling to their afflicted spirits
than friendship, and the society of those they love, nothing is more
grievous to them than its loss. To form such a feeling, is very
difficult; but by beginning and proceeding on these principles, showing
them that truth and justice and kindness are the basis of our actions, we
establish a wonderful moral influence over them.
It will often happen, however, in stating to them that their minds are
not considered in a right state, they will stoutly deny it. I then
assure them, I shall be very glad to find they are right, and hope they
will not force upon me by their conduct, a different conviction. Stating
to them very gravely, what I understand has led to this conclusion,
saying, if we judge by the acknowledged rules of the world, they must
confess there is something very unusual and strange in their words and
actions; but at the same time, I trust they will not in future commit or
lose themselves, as it appears they must have done. In which case I
promise them I will myself befriend them, and endeavour to replace them
as soon as possible, in the confidence of their friends, but which I can
only do when their conduct will enable me to transfer to their friends
the confidence it has given me. Many, of course, assert, that what
others call insanity, they know to be correct and proper; then I say, we
must have time to examine it at leisure, that it is too weighty a matter
to determine in haste. Where the person cannot be made to comprehend all
this reasoning, of course other methods must be adopted, according to the
nature, exigencies, and the state of each patient. In fact, it is
impossible to state all that is, or ought to be done on these occasions;
we can only hint at the spirit of the procedure, for every separate case
requires its own appropriate plan of procedure.
To show the propriety and advantages in this method of proceeding, I
shall state the important fact, that some few have at once been cured,
without removal from home, by the powerful influence of its candour and
honesty.—And in all cases, when, after all this labour and delicacy, they
are removed, and are, subsequently, on the same principles, and in the
same spirit, treated with every possible indulgence, and the greatest
degree of forbearance, even overlooking many lesser faults, and waiting,
until, as we say, “they break out and commit themselves,” in some very
decided manner, so as to furnish us (even in their own estimation) with a
very palpable plea to abridge them of their indulgencies, they have then
forced upon them the conviction of their error, and are obliged to
acknowledge the justice of any change that is made.
It is singular, that many have on this plan been speedily cured by the
self-restraint this system conspired with other things to give them; and
many others have recovered without ever feeling or considering themselves
as having been treated as insane patients; and most of them do not
consider themselves as under any confinement whatever. Not more than
about 3 p. cent. suffer any personal restraint, and not one for years
under any constant personal coercion, and we have, at times, been for
months together with not more than one patient whom we were afraid of
trusting in the grounds alone.
I must more particularly advert to this most powerful argument in favour
of this plan, which is, that it conduces to form the habit of
self-control, which _is the habit above all others_ which ought ever be
our aim to form. It ought to be the primary object in every moral plan
of cure. But I shall have some further observations to make on this
principle, and the various means which tend to form and increase it, in
another place. I only hint at these things at this time, for the purpose
of showing that all these delicate, modified, conditional, and
encouraging plans of superintendance are assisted by the arrangements I
have described.
In fact, so important have I considered this plan of Classification, that
when I first came to Leopard’s Hill Lodge, I contrived the best way I
could, with my means, to have a family and front part of the house,
independent of the galleries; and should I be called upon to extend my
plan to meet my increasing success, and should my life be spared, and
time and health permit me to follow out my views and to build an Asylum
upon a larger scale, I should keep these principles of Classification, as
well as many others, in view, in the plan I should adopt, for I am more
and more confirmed that they are extremely important; and I may mention
as proofs, that at all the houses we have had parties in the front part,
who would, in their conduct and pursuits, and social enjoyments, put to
shame many families who are reckoned perfectly sane. We have visiting
parties from house to house, with the usual amusements of cards, chess,
billiards, cricket, &c. For some months we published a weekly newspaper
of considerable interest. Nor is it unworthy of notice, that some
articles of a very superior kind in our critical Journals have been
written in this place; all which gives it more an air of social enjoyment
and comfort, than the coldness and repulsiveness usually attendant on the
loss of liberty, and forms within ourselves a little world of interest,
better suited, I believe, to the state of the inhabitants than the real
world could be to them. It is, in fact, a System of Classification,
originating, if not in the most enlightened, at any rate in the most
humane considerations of the various states and maladies of mental
aberration, and which enables us to exercise a powerful influence over
those under our care. It is in agreement with our conviction of the
importance of that which may be laid down as a maxim, that, if the mind
be maintained in a state of tranquillity, the affections are more likely
to be brought into a right state, the effects of functional disorder, or
even disease, to subside; the mists of delusion to clear away; and the
light of the understanding to resume its province.
The last and most important consideration is, that this plan has induced
several (especially before the letter and spirit of the law were opposed
thereto) to return voluntarily on their perceiving symptoms of their
returning malady.
I could give, were it not that motives of delicacy forbid me, some very
striking and interesting cases, illustrative of these facts and these
principles, and the beneficial results which arise out of them.
One of these cases, illustrative of this necessity of more delicate and
intellectual treatment in certain states of mental aberration, I am
advocating, I may mention. It is that of a lady who had been, upwards of
seventeen years, in alternate states of excitement and depression, and in
confinement all this time, whose recovery I attribute, combined with
medical means, principally to such attention.
_No._ 335 _was first admitted of her own accord_, _March_ 5_th_, 1826,
_aged_ 56; _discharged May the_ 4_th_, 1826; _again returned of her own
accord_, _June_ 30_th_, 1826 {36}
This case was a most striking sample of a great number of a similar
description, who are the subjects and victims of this perverse and
irregular mental excitation, which become, without proper management,
more confirmed cases of mania and melancholia, which continuance in this
state for a sufficient time, produces disease, and disorganization of the
brain, and ultimately terminates in incurable dementia, either of a
partial or more general character.
She was a person of a highly sanguine temperament, possessing by nature
great capabilities, but her intellectual powers had not, by education or
circumstances in life, been so much developed and increased as her
energetic feelings, which were most excitable, strong, and active. If
her education had equalled her natural endowments, her understanding
would have assumed no common pre-eminence, and in which case her feelings
would probably have been brought under due subordination. It was not,
however, so much even the defects of her education, as the circumstances
of her life, and especially those connected with her religious
associations, which were incomparably more calculated to increase the
strength and activity of her feelings, than to call forth and cultivate
her intellectual powers; indeed, instead of any such cultivation in any
proportionate degree, there is every reason to believe, these
associations had a paralysing influence; nor perhaps were any habits of
self-control, or any mental restraint whatever, formed or acquired in
this connection, except that which operated too exclusively on her
religious and conscientious fears; and hence, without entering into the
details of her history, the result was the formation of a character, such
as is most common under the present artificial systems and circumstances
in modern times, ill formed to withstand the effects of adverse or
prosperous fortune.
It was her lot to pass through these extremes, and after suffering many
reverses, mortifications, disappointments, bereavements, and some matters
of a private and most afflictive nature, she had a rheumatic fever, when
the explosion took place; then the weak and over-exercised parts of her
mind displayed themselves in an irregular and increased degree. Her
state was an exaggeration of her former energetic and acute nervous
sensibility, operating alternately on the depressing, and exhilirating
passions.
When she came to me, for she had been in various places previous to this
period, she was in a state of religious melancholia. Her conscientious
fears were dreadful, and her misery extreme. She conceived herself
condemned to eternal punishment—she was already in torture. When in this
terrible state, she had more power to engage one’s commiseration, than
any patient I ever had. Her descriptions of her own state were extremely
eloquent and affecting, and her appeals for sympathy were overpowering
and irresistible, and I was absolutely worn out and overcome by the
fatigue and misery I endured in my efforts to console and restore her. I
shall always continue to feel the painful effects of my anxious exertions
in this and several similar cases of melancholia; but no case and perhaps
no number of cases, shook and overwhelmed my nervous system as this did,
(unless it be one through whom I had a nervous fever); not merely because
of her extreme agony, but my own health and spirits were then in a very
depressed state, having been for years a martyr to chronic enteritis and
gastritis. I mention this to account for the obligation I felt myself
under, to dissever my sympathies from this overwhelming influence, and to
transfer her to the kind care of Mrs. Allen, to whose lively and cheerful
disposition, uniform and judicious kindness, combined with great firmness
and gentleness, soothed and softened her melancholy state, and, in time,
tempered the extremes to which she had been subject, and kept her spirits
in a better direction.
One great art in this management was that of Mrs. Allen’s making her
useful as her deputy in every thing in the house, either in matters of a
household nature, or in attending upon others. And notwithstanding her
own miserable state, no one was ever more qualified for a nurse, or
better understood every thing connected with the arrangements of the
table; and her very perfection in all these matters, had, before Mrs.
Allen came, been the cause of an increase rather than a relief to her
misery, for she became the object of great jealousy and dislike to my
housekeepers and matrons, on this score: but now it became a source of
employment, amusement, and diversion. Though she long continued to
possess, for the most part, this disposition to fall into the same
miserable state, yet it never afterwards degenerated into that dreadful
agony and distraction I have described. At times it ceased altogether,
and her more happy state supervened, when she was full of hope and
self-esteem, of life and activity, the very antipodes of her former
state. But it is altogether astonishing how both these states were
lessened and kept in check by Mrs. Allen’s manners, combining the most
inflexible firmness with admirable tact and good nature. When all her
almost exhaustless fund of sympathy failed, it was always found a
sufficient check, and at once to call forth our patient’s powers of
self-control, for Mrs. Allen to say that she really could not bear the
association of her miserable state any longer, and that they must
separate; and it was very seldom necessary to hold out the threat, that
she must be removed into the gallery and back part of the house.
Perseverance in this system of unwearied and perhaps unequalled kindness,
gradually mitigated and diminished these alternate states of excitement
and depression; thus shewing to demonstration, that in this way, with the
aid of medical treatment, the excitement of the depressing and the
exhilirating passions may be checked and restrained, so that in time they
may regain their due equilibrium;—that instead of these cases
degenerating, as they have almost always done, into hopeless cases of
mania or melancholia, and often terminating in complete dementia, they,
by this system, might in process of time regain the due equipoise, or the
relative and appropriate share of the exercise of the different functions
of mind, and be brought, as in the case just described, to repossess the
greatest of blessings, the healthy action of the feelings and faculties
in the discharge of those duties which constitute alike the object, the
usefulness, and the happiness of her present existence.
I mention such cases, because I shall hereafter do all I can to draw
attention to similar mental states, as the common causes of insanity.
That almost all cases _begin in this way_, but that they are disguised or
kept from our view, with those who possess self control, until (unless
the tendency be cured by such efforts to disguise it) they at last burst
forth into some form of insanity; and indeed insanity itself may be
defined generally, the uncontrolled over-excitement, imbecility,
suspended or paralysed state of one or more of the mental functions,
arising from some previous faulty state of action. I shall have to show
hereafter how all these cases might in their incipient and curable stage
have their specific modes of moral and medical treatment applied in order
to counteract and cure them; and by this method incurable cases would be
almost unknown.
At the same time let it be observed, that such treatment requires much
more delicate and intellectual attention than is in the power of those
who for the most part live amongst the insane, and, have the direct and
important management of them; and that, in justice to ourselves, I have a
right to assert, that where such treatment has existed, and does exist,
it is not a matter which money can remunerate, and that in this case
there was no pecuniary reward. It was no such inducement that had any
influence in regulating the conduct which we pursued with such unwearied
diligence; and not merely was there no pecuniary reward, but even
gratitude was wanting for a time; for this attention was so delicate,
that she was always made to feel she was the person conferring rather
than receiving favours; so that when she was relieved from her depressed
state, and it was superseded by the excitement of the exhilirating
passions, her self esteem dwelt only on the favours she imagined she had
been conferring. _She was useful_, but her usefulness was more for her
own good than for ours. Indeed, we paid the price of patient endurance
to a degree and extent which can never be conceived or known, still less
was she in a state to perceive or appreciate our motives, therefore she
conceived, and was confirmed in the impression that she was actually the
person to whom obligation and gratitude were due. This impression was
the last remains of her disease, or of that over-excitement of the
exhilirating passions, which with the longer-continued paroxysms of the
over-excitement of the depressing passions, constituted the character of
her case; and she left us, not merely before the “high state” had solely
subsided, but at the very time when we felt it to be our duty to restrain
and subdue it, and of course when she felt most mortified, and was least
able to perceive and appreciate our motives, but which she has since done
to our entire satisfaction.
She has now been upwards of three years in the world, engaged in useful
and active duties, and though she may be liable to extremes, and be too
susceptible of the action of exciting causes, yet I have every reason to
believe, that experience has taught her the necessity of counteracting
and restraining their baneful influence. I am told by her friends, that
now collision with the world having smoothed down the peculiarities which
her long seclusion had contracted, her character appears much improved.
I might detail many such cases, and prove that cures have apparently been
effected by this intellectual and delicate attention, and more especially
in some slight and incipient cases. But I may also state, that many
cases of the most serious kind have been so treated, and have recovered.
I particularly have in view, two cases of the most determined suicidal
melancholy, that were so delicately treated and watched, that they were
not themselves aware for months, they were even in a place of
confinement, or they had an eye of anxiety constantly watching over them.
To this watchfulness and constant exertion to amuse and divert them, I
principally attribute the gradual diminution of their melancholy, and
ultimately their recovery. These cases, No. 412, and 373, have each
returned three or four times of their own accord, and have each time,
under this system, gradually recovered.
Is it not then of importance that we should do every thing possible to
lessen the present feelings of horror associated with such places? then
might we expect to find them come of their own accord, have confidence in
their medical friend, concur and co-operate in the plan marked out for
their cure, and the consequence would be, that we should find them
generally recover.
_No._ 373 _came of his own choice_,
And was a most distressing case of hypochondria, which had from various
causes been increasing upon him for about twenty years; and when he so
came, he was in the most depressed and melancholy state possible. His
whole mucous membrane had long suffered from chronic inflammation, and
was in a state of the greatest irritability. He was, in less than nine
months, altogether another being; his habits were altered, and his health
greatly re-established; and this person was one whose cure was partly to
be attributed to my mode of amusing him. I do not mean to enter into his
particular history, or his medical treatment, for it would itself make a
volume; but I introduce a brief notice of his cure, for the sake of
illustrating the foregoing principles of Classification, and to show that
a variety of methods are necessary to accomplish the object we ought ever
to have in view, and that it would never answer to apply indiscriminately
the same medical or moral treatment to any two cases.
A plan was proposed to spend an hour at least with him every evening, and
this hour I devoted to that of detailing to him a history of my own life,
always contriving, in the style of the Arabian Nights Entertainments, to
break off suddenly at some point of interest; and these conversations,
had they been committed to writing, would have formed some very amusing
volumes. The great art and merit of the plan consisted not merely in
making them amusing, but in contriving to introduce, without appearing
intentionally to do so, (that I might not in his over sensitive state
offend him), facts and views calculated to counteract the errors and bad
habits into which he had fallen.
In all cases it is necessary to know every extreme view and error to
which the human mind is liable, and where these exist, as inmost cases of
insanity, to endeavour to counteract them by clear and beautiful views of
the truth.
What is of the greatest consequence, is that it is still more necessary
to know the best mode of making truth admissible and effectual; for it
ought never to be forgotten, that in all cases where error and delusion
exist, even if we know those views which are best calculated to
counteract and remove them, still more depends on the manner,
circumstances, and spirit in which we present and apply them. I am
anxious to draw attention to this truth, because it appears to me the
world at present has no adequate conception of this great and necessary
art in its propagation: still less does it appear that mankind, nor even
many medical men, have formed any proper estimate of the vast importance
of such a system in the treatment of the insane: a system, however, which
requires that we should be fully acquainted with the history of man, and
be able to perceive the causes and effects of false and perverted views
of philosophy, morals, and religion, and above all that we should possess
a knowledge of the constitution of the human mind, with all the specific
differences of every individual case.
I mention this case with others, to show that there are many instances
where something more than common attention is required, and that to such
patients we devote ourselves, and have them at our own house for this
purpose. These are precisely those who are over excitable. They form a
large proportion of the insane, and in their incipient stage, their minds
are rather in a state of perversion, than absolutely lost or deranged;
whose cure depends on correcting this perversion, and restoring the
relative and appropriate share of activity and energy to each function,
in the exact measure, proper place, and according to the order of their
right distribution.
If then, these houses serve these various purposes, who is best able to
judge when such purposes can be best served? The exact moment lost can
never be regained! a wrong word, or even look, may unhinge, and bring on
a relapse! It is a species of discipline like that of a
nursery;—children commit some fault, and are removed from the objects of
their affection as their punishment; and no punishment is greater or more
effectual. Some of our circle break out into passion, or give way to
some strong propensity; they are told it won’t do, and are removed: they
soon promise to behave better, and return. The causes are sudden and
unexpected, and sometimes trivial; and this mild medicine, instantly
administered, has a wonderful influence. Sometimes the attendants will
be better suited for some specific cases at one house than at the other;
and it may be injustice to other patients to change them, but great
justice to change the patient on their account.
When I state to patients’ friends these matters, and the difference of
these houses, I say decidedly, that in those cases to whom our attention,
and the comforts of the domestic circle may be useful,—those friends
should, if they possess the means, prove, by a corresponding
remuneration, that they duly estimate such delicate attention;
particularly as they do generally acknowledge that it is not in the power
of money to compensate for the expenditure of so much feeling, and being
subjected to so much annoyance. In all cases where it appears this
attention and placing them in our domestic circle, will contribute to
their comfort or their cure, we, as a matter of feeling and of duty,
treat them with equal kindness and attention, always giving
considerations of comfort and of cure, the first place.
Besides, most cases are improved by association with those of a different
character. I have seen many old torpid cases, and a still greater number
of recent cases of suspension of mind, cured by being placed occasionally
among those who were in a more lively state, and this after every other
means had failed.—And it is reasonable, for nothing can exceed the comic
effect of the strange and laughable speeches and manners of some among
this class of patients; and, in the case, the treatment of which was
altogether mistaken or mis-represented, there was surely nothing
incredible or unreasonable in saying I preferred, that this lady should
have the chance of being roused out of her torpid state, by remaining at
Leopard’s Hill Lodge, where of course, she might have these means
occasionally put in force; for all the females were then at that house,
and at the same time, she did possess the advantage of every possible
delicacy of attention from Mrs. Allen, who was, with her children and an
additional number of servants, then living altogether at that house.
The case No. 335, was, as I have already mentioned, always soonest roused
out of her melancholy condition, by being placed for a short time in the
midst of such association. It would be contrary to the economy of
providence, as exemplified by the constitution of society, to place all
the melancholy in one class, and all the lively in another. The truth of
this argument receives additional confirmation, when we consider, which I
am prepared to prove, that insanity in many cases, is produced by, and
consists of, an aggravation of the original peculiarity of character, and
therefore it is evident, that such collision, like collision in the
world, is making one extreme tend to correct another, though of course,
the worst and most dangerous cases of every description, are not in their
treatment included in this principle.
Many instances are recorded, of two opposite cases, by being thrown
together, neutralizing, like an acid and alkali, each other; that is, the
melancholy have been roused by the lively, and the lively depressed by
the melancholy, and thus both have been brought into a better state.
Sometimes the insane have been cured by witnessing their own case
caricatured in that of another. For instance, two proud men, the victims
of their gradual and progressive false estimate of themselves, assume in
their insane state, the same crown and kingdom, and by witnessing each
other’s delusion, have been forced to feel that one must be in the wrong;
and thus, one or both were brought to reflection, and ultimately to a
more sound and sober state of mind.
Even the imbecile and idiot, are roused and improved by such
associations, more than they had been, even with every endeavour to
improve them, while they were in a state of seclusion. I have lately had
two very remarkable instances of this kind.
_No._ 425 _and_ 429.
Imbeciles, though they were from birth, they improved after their
arrival; the scene was very different to the solitude in which they had
been placed; the common scenes and circumstances of life, had not had
sufficient power to rouse the dormant and torpid state of their mental
functions, while scenes and circumstances, that are in themselves very
painful, were better calculated to arouse in their moping minds,
something like feeble efforts of reflection. I have seen them behold the
strange antics of others, with intense wonder and interest.—Often they
will catch the contagion of laughter; and thus if the understanding has
no part in the matter, their spirits, at all events, partake of the
merriment of the scene around them; and though insanity, considered in
the abstract, is a melancholy thing, yet it is a truth, that there is
much more of merriment than melancholy among the insane. I believe their
average of happiness is greater than would be found among the same number
in the world. Those who look with prejudice from impressions received
from a few extreme cases, of course make out a different conclusion.
Again, there is another consideration, which further proves that the
happiness of these imbeciles and ideots may be increased by such
association. They have still the blind affections craving for food, and
they here find food for their gratification, better suited to their state
than they could find it in the world. These affections without
understanding, are to the world repulsive. It is strength of affection,
guided by strength of understanding, that so powerfully attracts and
binds society together. In this sphere they cannot revolve; here,
eccentric as it is, they have one better suited to their state.
I daily see ideots and imbeciles taught to walk arm in arm; evidently
pleased and gratified that they have objects for their blind affections
to rest upon. Besides this, it is a very singular and remarkable fact,
that this exercise of their affections, has contributed to the
improvement of their physical state. Whatever increases innocent
enjoyment, and contributes to happiness, are excellent medicines. Peace
and purity of mind are better than physic. This exercise of their blind
affections conduces alike to their felicity, and to the preservation of
their health, by innocently keeping alive the regular and happy exercise
of their animal spirits, by the only outlet they possess, that of their
blind and instinctive affections; and hence, it is very remarkable, that
in consequence of their animal spirits being no longer pent up, as was
formerly the case, they are not now so liable to those sudden bursts and
irregular displays of passion, to which they had been the victims; and
what is still more remarkable, they are in better health, and not so
liable to cramps and colics, which had been the corresponding physical
effects of their irregular nervous distribution; so that even with them
the truth is evident, that it is not good to be alone; the little world
they live in is better suited to amuse and contribute to their happiness,
than the quietude of civilized life, from which they could receive no
enjoyment, and to which they could only give pain.
It is also worthy of remark, that some patients sink more rapidly into
moping idiotcy when kept in a state of perfect seclusion, than they even
do in the society of those who are insane like themselves.
I have seen patients who had not been accustomed to any association, who
were, on their first arrival, in appearance, manners, behaviour,
especially in their mode of eating, and their dirty habits, scarcely
human; it was evident from all this, that they had long been unaccustomed
to the common conveniences and decencies of life, as well as from the
astonishment and delight they first exhibit, on these things being
restored to them;—to see companions, and to find a table with the usual
appendages of knives and forks, &c. evidently excited pleasing
reminiscences and gave them additional life,—their improvement
(externally, at any rate) was rapid, and, by continued attention, their
restoration to habits of cleanliness complete.
To insure all these as well as many other advantages, and to make cure
the primary object, requires not only that the proprietor should live
amongst them, but also that he should be a medical man, and one who has
experience, guided by upright principles and Christian feelings; for if
medical men of talent and character could be induced to undertake this
painful and anxious life, submitting cheerfully to all these sacrifices
and inconveniences, much might be done to improve this neglected
department of medicine, and augment the number of cures; at all events,
most certainly increase the comforts of the incurable, and lessen the
distressing apprehensions of those who fear the accession, or recurrence
of mental aberration; yet notwithstanding the paramount importance of
these things, so ignorant or so blinded by prejudice is the world on the
subject, and so little aware of the talents and capabilities required for
such a situation, that they consider the very name of a proprietor, and
superintendant of an asylum, as absolutely sinking the character in
public estimation; whereas no class of medical men, were they efficient,
should be considered more honourable, because none can be more useful
than those who devote themselves to the cure and comfort of persons in
this most lamentable state.
When the gloom and horror at present thrown around establishments for the
insane shall be cleared away, Dante’s inscription over the gates of Hell,
will be no longer applicable to them,
“Lasciate ogni speranza, voi, ché ntrate;” {55}
this, or perhaps another passage from Euripides, has been imitated by our
Milton,
“Here hope never comes, which comes to all.”
They will be considered houses of cure, or hospitals for the insane.
The erroneous and false impressions, concerning the character and state
of the insane, will be corrected. The popular impression, that they are
all violent and vociferous, destructive and dangerous, will be removed.
Hitherto medical writers, by selecting the most striking cases, have
contributed their share to this popular error. They have been led to do
this, partly because they are cases, which more naturally arrest their
own observation; but chiefly, because they are more easily described;
make a more interesting picture, and are the most curable. A statement
of the recovery of such patients, though it may serve to exalt the writer
in public estimation, is wrong in itself, and very injurious in its
influence; for it increases the unreasonable horrors and false
impressions entertained about the insane, and propagates and perpetuates
the evils of which the public and legislature complain. They receive
impressions from extreme cases, which average about five per cent. then
speak just as if all the insane were in a similar condition.
Mr. Samuel Tuke says, “Many errors in the construction, as well as in the
management, of asylums for the insane, appear to arise from excessive
attention to safety; people in general have the most erroneous notions of
the constantly outrageous behaviour, or malicious dispositions of
deranged persons; and it has in many instances, been found convenient to
encourage these sentiments, to apologize for the treatment of the unhappy
sufferers, or admit the vicious neglect of their attendants.”
In the construction of such places, cure and comfort ought to be as much
considered as security; and I have no hesitation in declaring, that a
system which, by limiting the power of the attendant, obliges him not to
neglect his duty, and makes it his interest to obtain the good opinion of
those under his care, provides more effectually for the safety of the
keeper, as well as of the patient, than all “the apparatus of chains,
darkness, and anodynes.”
“The safety of those who attend upon the insane, is certainly an object
of great importance; but it is worthy of enquiry whether it may not be
attained, without materially interfering with another object, the
recovery of the patient. It may also deserve enquiry, whether the
extensive practice of coercion, which obtains in some institutions, does
not arise from erroneous views of the character of insane persons; from
indifference to their comfort, or from having rendered coercion necessary
by previous unkind treatment.”
But there is another fact to be considered, not hitherto contemplated by
any writer, and which is well expressed in a letter I received from a
friend, in answer to one requesting his opinion in a case {57} wherein
its importance has been shown to demonstration. He says, (and he is a
man of great humanity,) “I am most solicitous that the distinction should
be understood between those who cannot act and think or decide for
themselves, and those who can, and who, sensible of their defective
state, or of the approach even of absolute derangement, can of their own
free will, place themselves in a situation, where they know that every
medical and moral means will be used for their restoration. It is of the
utmost importance, that the legislature should have it completely
demonstrated to them, that there is a condition of the insane never
contemplated by any legislator; the judicious management of which, is of
the greatest consequence to them. Instead of the mental malady being
allowed to proceed, until the sufferer is introduced into these retreats
by force, its first approaches will be yielded to as soon as recognised,
and the unhappy individual, whilst still in the possession of reason,
will voluntarily or by gentle and affectionate solicitations, enter some
refuge for mental distress, where, separated and secluded from the scenes
and circumstances which were hurrying on intellectual destruction, he
may, in a short period, in a condition of comparative happiness, escape
the most tremendous calamity with which human nature can be assailed.”
I believe all the former evils connected with the management of the
insane, have arisen from ignorance of their state; and therefore I am
anxious to be perfectly understood, and labour most earnestly to correct
this erroneous impression; and not only so, but I wish to prove the
popular prejudice, that they are all ill treated, to be no where, as far
as my knowledge extends, true or deserved; neither am I aware that this
branch of medicine has been more abused than others; nor do I know in all
my experience, of any unjust confinement for interest’s sake; there may
be ignorance of the treatment required, but surely in these enlightened
times, a medical man of any character can never lend himself to any thing
so suicidal to his own fair character and prospects. I know, on the
contrary, of evils arising from over caution in the other extreme. I am
perfectly convinced that no insane person, should be without medical
superintendance, and that to be placed singly in private houses, not
medical, I know from experience to be sometimes most fatal and
destructive; some few, it is true, are above all praise.
Sir Andrew Halliday after stating the number of insane, who are known and
registered according to act of Parliament, says, “there is a number, if
not equally great, at least nearly so, of whom the law takes no
cognizance, and whose existence is known only to their relations and
friends. These consist of individuals placed in solitary confinement,
with persons who take only one patient. This is a state of things which
ought not to be allowed to remain as it is, for a single hour, in this
boasted land of liberty; I do not say, that it ever has taken place,
though I have known one or two instances that might almost bear such a
construction;—but I maintain that it may take place, for there is no law
to prevent it; that individuals may have been sent into such seclusion,
who never suffered from the pangs of madness; and it must be evident to
every one who gives this subject the least consideration, that it only
requires a faithful keeper, and that watchfulness, to retain such a
person in prison for life. This number is said to have been prodigiously
increased by the new Act.”
At the same time it must be allowed, that many incipient cases, requiring
seclusion and separation from friends, would be aggravated by too sudden
an introduction amongst masses of insane patients; and even by the very
circumstance of arriving when there is the chance of exciting the usual
horror and prejudice entertained against such places; but this ought not,
and would not be the case, were the plans and systems of classification I
have advocated, carried into practice. Every way and in every thing, we
have imperfections and abuses; and it is much easier to condemn than to
cure them; and they who at once believe abuses exist in proportion to the
popular description that is given during some temporary excitement and
prejudice, are not safe persons to have the important charge of removing
them. I make these remarks, to show, that while a paternal government is
justly, most anxious to protect the persons and property of those who can
no longer protect and defend themselves, they should at the same time
remember, that sanity of mind is still of much higher value; and that
therefore concern about the property should not out weigh our concern for
the cure.
I say nothing in the mean time, of the degrading suspicion and paralyzing
interference, which the best and most conscientious man may under such
system feel, in proceeding with the plans which, he from experience,
knows to be essential to their restoration; but I contend, that the
_common error in legislation_, _of making property of more value than
life_, must here as well as wherever it is committed, have a baneful
influence. In this instance, the acts or laws made under the influence
of this very great and very selfish delusion, produce this very serious
mischief, that they tend to increase the prejudice and aversion common to
places of this description, some of which would otherwise be considered
not merely unobjectionable places of residence, but places of seclusion,
very agreeable in themselves, and most desirable as places of cure.
In many complaints, change of scene and association, are justly
considered necessary to the restoration of health. It is not only the
same in many cases of insanity but absolutely the first and most
important step in every system which gives them a chance of restoration.
Should then a bare residence in any place for the mere purpose of cure,
be accompanied (in very many cases, it is unnecessary,) by an act which
is considered as fixing the mark of degradation upon them, any more than
it should in any other disease? This, instead of healing, is calculated
to crush a heart already breaking; it is often fatal to their recovery!
it is a principal cause of frequent relapses! They feel a stigma, thus
fixed on their character, so confirming the prejudices of the world, and
so encouraging that distressing and fatal look of suspicion towards them,
that they are forced to feel that no one reposes any faith in them; and
if this feeling does not ultimately destroy all comfort and confidence,
all order and stability within them, it must very much weaken that
concentration of energy so necessary to the successful exercise of all
mental operations; and if their minds are weakened by previous attacks,
and not well sustained by right principles, but on the contrary, like
many others, merely regulated by worldly principles and considerations,
then, they are not only deprived of the rock on which mind is based, but
also of all the motives and objects which stimulate to mental action. In
this state, what is mind but a sad wreck floating on the fathomless ocean
of life, at the mercy of every wind and wave? To what else shall we
compare its situation?—It is like a city broken down and without walls,
any enemy may enter in, and overthrow it. Can we wonder then that
persons whose minds are in this position, and whose prospects in life are
thus blasted, should have a recurrence of the same awful visitation? or
what is worse, that they should constantly feel their spirits paralyzed,
and a melancholy gloom thus thrown over the remainder of their existence!
To make it necessary in all cases to have certificates, so far from being
a security against abuse, is more likely to be a cloak for those who may
wish to take advantage of the patient’s defenceless state; whereas in
cases of voluntary seclusion, there can be no risk; for with such
honourable confidence, we have at once, the proof and the security that
it cannot and will not be abused. These, however, are not the most
desirable inmates, as it regards the ease and comfort of the
superintendant, and therefore no one can have any other motive in
recommending this practice of voluntary seclusion, but that which arises
from the conscientious consideration of its being more conducive to cure.
That all should have the sanction and concurrence of medical
recommendation, is every way indispensable; but what I argue for is, that
this should be done, in the manner best calculated to make it appear to
the patient, that cure, and not mere confinement, is the object of the
measure they are recommended to accede to without reluctance. That a
great number will require certificates, and all the aid of authority, to
make them submit to the measure, is certain; and in these cases, the law,
so far from being a hardship, is a great convenience and advantage.
Again, violent and extreme cases may be said to certificate themselves,
in these there can be no risk of making any mistake, and doing any
injustice in the first instance; the injustice may be afterwards in
improper treatment, and in over detention. But to prevent all such
abuses, we must first make men perfect, and then we should have no
diseases to cure. It is certain, that under a proper system, ameliorated
by all these plans of procedure I have stated, it is astonishing how
these violent and extreme cases would become less prominent. I believe
they would not average five per cent. at any one time; and take the
average of a number of years, and I suppose it would not be more than
half that number. I am certain the proportion, during sixteen years of
my experience, has been much less than even this; it is seven years since
we had occasion to treat any one single case as a constantly furious and
dangerous maniac; and even suppose, such cases, under the best
management, were more frequent in occurrence, and continue in this state
for some time, how easy it would be so to contrive an Establishment, that
these violent cases should not annoy or disturb the rest; and when thus
managed, so far from their influence being hurtful, they would become
interesting and salutary objects of reflection and commiseration to those
who are in a better state; and often, by example, would teach the
greatest of all moral lessons, that which holds the primary place as a
preventive, and is always a necessary adjunct in the business of
restoration—self control.
In fact, every system of management that does not make this principle, of
mildly calling forth and gently exercising this internal principle of
self-control on matters that are least connected with the diseased parts
of the brain, a constant and primary object of attention, is not merely
defective, but exhibits very great ignorance of the attributes of mind,
as well as of the causes and nature of its maladies; and it follows that,
as a system, it must be without any clear principle to guide its physical
and moral treatment. In all things, we ought to remember, and especially
in a matter of such importance, that we can do good only so far as our
knowledge extends; and even this knowledge is useless, unless we are
zealously desirous and able to reduce it to practice. Whatever may be
our proportion of knowledge, zeal, and ability, it cannot be arrogance,
when called upon, to say, that I believe this principle is more brought
into practice by the plans and arrangements I have described, than is the
case with any system of treatment in any place that I have hitherto heard
of or seen.
It is not known, as it ought to be, how powerful with the higher class of
patients is the principle of honour; with many, a sense of religion; and
with _all_, the fear of losing the approbation and friendship of those
who are kind to them; as well as, from selfish motives, to secure the
liberty and indulgences they have enjoyed. These means, and every
principle which operates on human nature as checks on one part of the
mind, and as encouragements to another, should be constantly and steadily
kept in view, for the purpose of never losing an opportunity of instantly
bringing them into useful, and of course successful, operation.
It is on this philosophical system of kindness, that every thing should
be so contrived that the principle of internal self-control should be
excited, and kept in exercise; and thus, being brought to depend somewhat
on themselves, the depressing effects of the absolute restraint of fear,
induced by harsh measures, and the tyranny into which a mere place of
confinement with walls, and bolts and bars, must almost necessarily
degenerate, is avoided.
The propriety of these measures will receive additional confirmation,
when we come to consider the causes as well as the nature of the evils
which we are called upon to combat; but it may in the mean time be
sufficient to state the appalling fact, that insanity is very often the
consequence of early over indulgence.—I have frequently had to remark
that an only child,—the youngest, or one brought up by a
grandmother,—were the victims of a system of gratifying the feelings,
without due attention to the cultivation and exercise of the
understanding, as the delegated power destined to guide the future man.
There are few minds, even amongst the insane, who are not accessible to
the salutary influence of this kind and liberal mode of proceeding. It
is true, that many paupers, who have long been subjected to a very
different system, are scarcely receptive of any of the impressions which
belong to human nature; but with a higher class of patients, this can
seldom or never be the case, unless it be in cases of absolute dementia.
Even in the height of the most furious paroxysms, it is astonishing how
much may be done by liberality and kindness. Nothing but absolute
necessity should justify absolute restraint. It must always be
considered as an evil to which we are reduced, in order to avoid a
greater. Whenever it is unnecessary, and continued too long, it will do
more harm than good: the furious will be made more furious, and the
suicide more determined to effect his purpose. Whenever the patient is
indulged with more liberty and behaves better, we must have forbearance
to the utmost extent, and submit to all possible risks, losses, and
expenses, rather than again have recourse to it; and when it is repeated,
the patient must be made, if possible, to feel that it is deserved.
Their faults, like those of children, must be viewed with pity. They are
the wild displays of feeling, without understanding. We must make
excuses for them; often overlook, as often visit them slightly, only
seldom with seriousness, and always with moderation, justice, and
prudence. No evil is greater than the evil of constantly chiding and
suspiciously watching for faults. It is an evil spirit that poisons and
inflames every thing within its sphere. A contrary spirit has a healing
influence; and though it requires numerous attendants, and makes the
whole business of superintending the insane a source of constant and
intense anxiety and solicitude, yet it is pleasing to have it in my power
to state many “striking” examples of its efficacy, but I shall,
notwithstanding, content myself with only slightly glancing at two or
three.
_No._ 372.
I shall not at present give the particulars of this interesting case,
except so far as is necessary for the purposes of illustration.
When he came from a private Asylum, he was in a state of the most
furious, destructive, and malignant excitement, and had been in this
state for so many months, that he was considered by his friends as an
incurable case.
I attribute his cure, chiefly to his being treated with apparent
confidence, and induced to work with a spade, when even in his worst
state—a state so dreadful, that the least word or wrong look would have
roused him to commit some dreadful act of vengeance, and it therefore
required two men to be constantly in attendance to watch him, and this
without appearing to do so.
He was induced to work with willingness, by being brought to believe he
had the contrivance, management, and superintendance, of some
improvements in the place; such as some alterations in the garden, and
especially that of making a new road from one house to another, which now
bears his name. It was observed, that after a hard day’s work,
especially if he had profusely perspired, he had a more sound night’s
sleep, and awoke somewhat improved in the morning; it is, however, to be
remarked, that all this time he continued to have a regular system of
medical treatment, which consisted in small repeated bleedings with
leeches, averaging about three times in the fortnight, with purgatives,
alteratives, and salines. It is impossible to conceive the delicacy that
was observed towards him. Not a word or a look was done to offend him,
let him speak or act ever so provokingly; and he was as perverse and as
provoking, as it is possible to conceive a perfect dæmon to be. His was
the exclusive excitement of anger and malignity, combined with the most
acute cunning to effect his destructive purposes. The serpent, the wolf,
the tiger, and vulture, seemed all that remained of the man. In this
state, to bring the better parts of his mind into life, was a great
difficulty. However, perseverance in this system restored him; and never
was gratitude greater, or more substantially evinced, than has been by
his conduct, and by that of his friends.
* * * * *
I can truly say, with Dr. Haslam, that “by gentleness of manner and
kindness of treatment, I have seldom failed to obtain the confidence, and
conciliate the esteem, of insane persons; and have succeeded, by these
means, in procuring from them respect and obedience;” and I am of the
same opinion with Mr. Samuel Tuke, wherein he states “that a large
majority of the instances, in which the malevolent dispositions are
peculiarly apparent, and are considered as characterising the disorder,
may readily be traced to secondary causes; arising from the peculiar
circumstances of the patient, or from the mode of management.”
It is worthy of remark, that where the patients have known the
superintendants when in a convalescent state, or in a state still capable
of estimating the kindness shown to them, they will much more readily
submit, and show much less of anger and vindictiveness, even in their
insane state. This effect will be still more striking, if they have been
in a place where a severer system is practiced, and where they have
become depraved and brutalised, by being subject to too much coercion.
Of this I shall state as much of a very interesting case as may
illustrate this great and important principle.
_No._ 395, _admitted Dec._ 3, 1829.
This patient, on her first admission, was suspicious, vindictive, and
implacable,—refusing food, and medicines, &c.—after recovery, and
returning voluntarily, she was confiding, affectionate, and submissive,
comparatively, even in her worst state.
On my seeing her at her own home, at the time of her second admission,
she instantly said. “Good God! had you been here three days before, you
had saved me!” On asking if she would like to return with me, she
instantly said, “above all things in the world.” She came, and was
apparently well in about ten days, and so continued for about seven
weeks, when she returned home: but in less than a week she came back in
the most raving and furious state, and yet nothing apparently dangerous
or vindictive; on the contrary, she showed affection and attachment to us
all; and if she displayed any vindictiveness, it was connected with some
past recollections: but this has been slight and evanescent, compared to
that which she exhibited in her former state;—a testimony, even from
among the insane, which shows how much depends on the directions we give
to each other’s mental energies. In this case, long walks in the most
secluded parts of the forest, often removed or lessened an approaching
paroxysm, and always superseded the necessity of having recourse to any
restrictive measures. She is now perfectly recovered, and returned home.
* * * * *
Now, it is evident that ferocious and furious maniacs are those, wherein
a direct system of coercion is said to be essential; and yet it is
evident, that these are cases where it must do the greatest injury. They
are those in which the animal part is excited and inflamed, and of course
all causes of irritation must increase it. It is adding fuel to the
fire, which already burns too fiercely—it is lacerating a wound which
requires to be mollified with ointment. The best-tempered house-dog
becomes savage by being constantly chained.
Restraint and coercion are only justified when used either from absolute
necessity, or as the mildest species of discipline; and then in all
instances it _must_ be proportioned to the causes and exigencies of the
case; or when they are so violent, or so unconscious of their own state,
or so bent on their own destruction, that there is less evil to be feared
by restraint, than by indulgence.—But even here, popular feelings,
prejudices, and fears, must not be the judges.
The word coercion has been used, but it conveys an erroneous impression,
as if some degree of punishment were necessarily included in the
restraint which the safety of others and of the patients require; but so
far from this being the case, it ought never to be forgotten, that if the
murderous and destructive maniac are made to feel, that with this
necessary restraint is conjoined the indulgence of a vindictive spirit of
retaliation, it will have an injurious influence, aggravate the disease,
and of course will progressively increase the necessity and rigour of the
restraint.
In cases of determination to suicide, it should be made to appear to the
patient, what in truth it always should be—the kindest guardianship and
protection. In cases of some lesser faults, or such as breaking or
tearing, instead of restraint, a small dark closet I have found more
useful than the strait waistcoat; yet neither the one nor the other,
have, now for a long time, (seven years at least) scarcely ever been
resorted to, for more than an hour or so; but to be able to do all this
requires a superabundance of servants and attendants, and these must be
serious, active, laborious, and vigilant as possible.
I have known cases where the patient himself, on feeling his destructive
propensity coming upon him, requested that he might be placed under
restraint, and he felt afterwards more comfortable, from the conviction
that he was safer in that state. In such a case, the request should be
readily attended to, as being not merely unobjectionable, but likely to
have a beneficial influence.
It has been, that restraint was resorted to, from the idleness and
carelessness of keepers; and in these cases, when restrained, being
neglected, they acquired dirty habits, very often, simply from the effect
of custom inducing a disregard and insensibility to the discomfort of
their filthy state; sometimes they acquired these habits, from, in the
first instance, a determined vindictive motive of teasing those whom they
thought had acted unjustly towards them, as the only means they had in
their power of gratifying their revenge. In cases of debility and
approaching marasmus, the effects of retention, when they are thus
deprived of the power of relieving themselves, soon destroys the natural
and healthy functions of the sphincters. I have often known a contrary
system cure all these habits especially in the two first class of cases
mentioned; though, in other respects, the mind remained the same. In the
case last described, good and judicious management may retard the
progress of the disease; but the system gradually decays, like a tree
stripped of its bark by lightning.
As a proof, we have only a choice of evils, and we must always choose the
least, I shall state a case.
_No._ 421.
This patient who had been several times under my care, was one who was
soon made worse both in his bodily and mental state, by any restraint,
however mild; and therefore we submitted to the losses which his very
destructive habits occasioned, rather than have recourse to them. These
losses were enormous. By this treatment, he so far recovered, that a
medical friend, who had known him all his life, declared, on an
accidental interview in the grounds, that his mind seemed in a state of
integrity, as perfect as he had ever known it to be previous to the
accession of any symptoms of Insanity.
In this state, he was removed by his friends from, I believe,
parsimonious motives, to Bedlam, and this was done in spite of my
positive opinion, declared in writing, that it would be fatal to his
bodily and mental health, and that he would sink under the depressing
effects of his situation. In less than six months, he was covered with
ulcers, and a mass of disease. In this state he was removed to his own
house in the country, where he recovered his bodily health, but his mind
is gone for ever.
* * * * *
I could adduce, to illustrate the same principle, many cases similar to
the last, and indeed so powerfully have I felt impressed with its
importance, that I have frequently written letters to, and had
conversations with, the friends of patients, stating, that from the
nature and state of their case, we had only a choice of evils, and
therefore it was better to run the risk of rather overmuch liberty, than
the positive evils of goading and exasperating them by what is generally
deemed, particularly in these cases, necessary restraints and
confinement. In most instances, they have not only fully entered into my
views, and given me their necessary co-operation, but also readily
agreed, that, if in consequence of this liberty any accident should
happen, they would acquit me of all blame, and we have hitherto been most
providentially favoured in having none of any moment. It is true, one
very peculiar patient takes advantage of this indulgence, and visits his
friends without leave of absence; but so far from any blame or anger on
the part of his friends against us on this account, they are pleased to
see him, and he is always on these occasions very happy with the idea of
having given us so much trouble, and at the same time, he shows he
esteems our kindness by willingly, readily, and cheerfully returning to
us. Indeed as we have no case which better illustrates the principle for
which I am contending, I shall here introduce so much of its description,
as may be necessary for the purpose of enforcing its importance.
_No._ 396.
It is a case, where little insanity is observable in his conversation,
but appears almost altogether in this constant propensity to indulge in
destructiveness—breaking windows, tearing his clothes, &c. The more
costly the articles he destroys, the more pleasure he seems to have in
the indulgence of this propensity for mischief and evil. By over-much
confinement and coercion, this patient would soon have become a settled
case of furious and destructive mania; but by great liberality, and using
restraint occasionally, the habit is much lessened: still, however, the
propensity exists, and might be easily aggravated. A week of the usual
coercive measures, would make this case degenerate into one equally
malignant and murderous as that of Walsh, whose character is given in the
Sketches of Bedlam.
* * * * *
A great number of cases might be adduced in support of these views; but I
trust these may suffice to enforce the argument in favour of the system,
which some have blamed, as being too liberal and indulgent. I have
therefore quoted a few such cases, both as an illustration of my views
and motives, and also as the best apology and vindication I can give in
my own defence.
In all violent cases, there is one remark that must not be forgotten—that
when it is possible, good may often be expected from violent exercise,
always taking care that the patient is in a state to bear the fatigue,
and still more so if he undertakes any sort of exercise with voluntary
pleasure. In cases, however, sinking into marasmus,—cases which I class
under those of gradual decay of mind—exercise must be undertaken at
suitable seasons, and when in a proper state, and must always be gentle
and moderate. Besides, though the greatest good may be expected in
almost all cases from labour and exercise, properly regulated, and
willingly undertaken, it is to be remarked, that while, with a great
proportion of a pauper class of patients, various kinds of labour and
exercise are, from their previous habits, easily adopted, and soon, by
vigilant management, reduced to a regular system, and such system is of
paramount importance to their health and mental restoration; yet with a
higher class of patients, who had not acquired at an early period of life
regular habits of industry, even the attempt to do the same thing might
be altogether as difficult and injurious; and therefore though exercise
is of very great importance, this should not make us overlook the
necessity of not urging and compelling them to it in a way to cause
irritation, unless indeed, in some extreme perverse cases, who must be
forced to walk or ride rather than their health suffer from deficiency of
air and exercise. What I mean is, that we must avoid doing a positive
evil where the good is only probable. For though exercise is one of the
most powerful means of withdrawing the determination of the nervous
energy and blood from the head, and distributing them properly through
the whole system, and thus combining a mental and physical power of
diversion to the train of thoughts which injuriously occupy and produce a
destructive fire in the mind, fatal to its existence; yet in these cases,
we may produce a greater irritation by unnecessary compulsion. It is
well known, that in many cases, besides the animal and angry passions
being very active, pride and vanity are with many, if not the whole cause
and very seat, often parts of the disease; and that when once excited,
all moral means to restrain and subdue them are as futile as it would be
to attempt by artificial aid to quench the fury of a burning volcano.
I have often, however, known the violent maniacal excitement very much
lessened in force, and bettered in direction, by being allowed, with an
attendant, to ramble, and dance, and scream about, in the secluded parts
of the forest, for a whole day together, and which superseded the
necessity of the straight waistcoat. {80}
When this class of patients cannot be induced to walk, they may be
pleased with carriage exercise, and in cases of approaching marasmus,
where much fatigue would be injurious, airings will amuse and help to
invigorate their feeble system, and perhaps, retard in some degree, the
progress of destruction.
Though I have incidentally been led to notice the importance of
employment and amusement, as a remedial measure of great efficacy among
the insane; and though I could adduce many further striking proofs of its
being apparently the sole cause of cure; I feel, to do so in this place,
would be to forestall and usurp a subject to which I intend (as it
deserves) to devote a separate essay; yet I cannot help saying, that I
have some recent cases in proof of its efficacy, that were it not that
their peculiar character and employment is so striking, that to describe
them, would be almost to name them, I should feel tempted to bring them
forward, for the purpose of proving that, among a better class of
patients, this employment must never, on any account, be made a
disagreeable task, but a matter of pleasurable choice, if we mean it to
have a beneficial influence. This is often very difficult; a task
requiring great tact and no selfishness. I believe, considering the
class of patients we have under our charge, I am justified in asserting,
that there is no place where a greater number, or more pains have been
taken, and greater sacrifices made, so to employ and amuse them.
Dr. Gregory used to mention the fact of a farmer, who, by giving his
patients, on their first admission, convincing proofs of his undoubted
strength and pugilistic pre-eminence, brought them to a state of passive
obedience and non-resistance, and then made them work; and, it is said,
cured them.
No doubt many would be cured by this system, and these would propagate
his fame; but whether the quality and proportion of those who would be
injured by such a system, were greater evils than the good which was thus
effected, we have now no means of ascertaining; nor is it necessary to
know this, before we venture to condemn a system so perfectly savage and
quackishly indiscriminate in its practice.
Where pride and vanity, angry passions, and love of power, are active, we
cannot, with impunity, force them to work against their inclination; at
the same time, it is our duty to lay the axe to the root of the evil, and
restrain, and if possible subdue, these inordinate passions; but what I
assert, is, that these are very difficult and dangerous passions to
encounter, and they are not, with this class, to be restrained and
subdued by the mere authority of a tax-master. When we encounter them,
it must be with great mental power and moral force; and this, even, to be
exercised with effect, requires, that we first make ourselves beloved and
respected by them. Oh! it is a difficult and delicate thing to preserve
that spirit, in combating these provoking cases, which alone has the
power to overcome and cure them.
A state of furious mania is frequently the effect of injudicious
management. Of this opinion, Mr. S. Tuke says, “a striking illustration
occurred in this Institution, some years ago. A patient, of rather a
vindictive and self-important character, who had previously conducted
himself with tolerable propriety, one day climbed up against a window,
which overlooked the court where he was confined, and amused himself by
contemplating the interior of the room. An attendant, who had not been
long in office, perceiving his situation, ran hastily towards him, and,
without preamble, drew him to the ground. The patient was highly
incensed: a scuffle immediately ensued, in which he succeeded in throwing
his antagonist; and had not the loud vociferations of this attendant
alarmed the family, it is probable that he would have paid for his rash
conduct, by the loss of his life. The furious state of the patient’s
mind did not continue long; but, after this circumstance, he was more
vindictive and violent.”
“In some instances, the superintendant has known furious mania
temporarily induced, by the privations necessary on a relapse, after a
considerable lucid interval, during which the patient had enjoyed many
privileges that were incompatible with his disordered state. Here we may
suggest the expediency, where it is possible, of employing such of the
attendants to control the patient during his paroxysms, as had little
intercourse with him in his lucid interval. Instances of furious mania
have been, however, very rare; but a considerable number of patients have
been admitted, who were reported to be so furiously insane as to require
constant coercion.
“The evidence of attendants, who have been employed, previously to the
admission of patients into the retreat, is not considered a sufficient
reason for any extraordinary restraint; and cases have occurred, in which
persuasion and kind treatment have superseded the necessity of any
coercive means.
“Some years ago, a man, about thirty-four years of age, of almost
Herculean size and figure, was brought to the house. He had been
afflicted several times before; and so constantly, during the present
attack, had he been kept chained, that his clothes were contrived to be
taken off and put on by means of strings, without removing his manacles.
They were, however, taken off, when he entered the Retreat, and he was
ushered into the apartment where the superintendants were supping. He
was calm: his attention appeared to be arrested by his new situation. He
was desired to join in the repast, during which he behaved with tolerable
propriety. After it was concluded, the superintendant conducted him to
his apartment, and told him the circumstances on which his treatment
would depend; that it was his anxious wish to make every inhabitant of
the house as comfortable as possible; and that he sincerely hoped the
patient’s conduct would render it unnecessary for him to have recourse to
coercion. The maniac was sensible of the kindness of his treatment. He
promised to restrain himself, and he so completely succeeded, that,
during his stay, no coercive means were ever employed towards him. This
case affords a striking example of the efficacy of mild treatment. The
patient was frequently very vociferous, and threatened his attendants,
who in their defence were very desirous of restraining him by the jacket.
The superintendant, on these occasions, went to his apartment; and though
the first sight of him seemed rather to increase the patient’s
irritation; yet after sitting some time quietly beside him, the violent
excitement subsided, and he would listen with attention to the
persuasions and arguments of his friendly visitor. After such
conversations, the patient was generally better for some days or a week;
and in about four months he was discharged, perfectly recovered.”
“Can it be doubted, that, in this case, the disease had been greatly
exasperated by the mode of management? or that the subsequent kind
treatment had a great tendency to promote his recovery?”
“It may probably be urged, and I am very well aware of it, that there is
a considerable class of patients, whose eccentricities may, in great
measure, be controlled; and who may be kept in subjection and apparent
orderly habits, by the strong excitement of the principle of fear.—They
may be made to obey their keepers, with the greatest promptitude; to
rise, to sit, to stand, to walk, or run at their pleasure; though only
expressed by a look. Such an obedience, and even the appearance of
affection, we not unfrequently see in the poor animals who are exhibited
to gratify our curiosity in natural history: but who can avoid
reflecting, in observing such spectacles, that the readiness with which
the savage tiger obeys his master, is the result of treatment, at which
humanity would shudder; and shall we propose by such means
“To calm the tumult of the breast,
Which madness has too long possest;
To chase away the fiend Despair,
To clear the brow of gloomy care;
Bid pensive Melancholy cease to mourn,
Calm Reason reassume her seat;
Each intellectual power return?”
“If those who are friendly to what may be termed the terrific system of
management, could prove, that notwithstanding it may fix for life the
misery of a large majority of the melancholies; and drive many of the
more irritable maniacs to fury or desperation; yet that it is still, in
its operation upon a large scale, adapted to promote the cure of
insanity; they would have some apology for its discriminate adoption.
If, on the contrary, a statement of the proportion of cures in the
Retreat, shall sufficiently prove the superior efficacy of mild means,
would not those, who are adopting an opposite line of treatment, do well
to reflect on the awful responsibility which attaches to their conduct.
Let us all constantly remember, that there is a Being, to whose eye
darkness is light; who sees the inmost recesses of the dungeon, and who
has declared, ‘For the sighing of the poor, and the crying of the needy,
I will arise.’”
“From the view we have now taken of the propriety of exciting fear, as a
means of promoting the cure of insanity, by enabling the patient to
control himself, it will, perhaps, be almost superfluous to state as our
opinion, that the idea, which has too generally obtained, of it being
necessary to commence an acquaintance with lunatics, by an exhibition of
strength, or an appearance of austerity, is utterly erroneous. The
sentiment appears allied to that cruel system, probably dictated by
indolence and timidity, which has so long prevailed, and unhappily still
prevails, in many receptacles for the insane.”
“There is much analogy between the judicious treatment of children, and
that of insane persons. Locke has observed that ‘the great secret of
education, lies in finding the way to keep the child’s spirit easy,
active, and free; and yet, at the same time, to restrain him from many
things he has a mind to, and to draw him to many things which are uneasy
to him.’”
* * * * *
It is highly desirable that the attendants on lunatics should possess
this influence over their minds, but it will never be obtained by
austerity and rigour; nor will assumed consequence and airs of
self-importance be generally more successful; at the same time, it must
be acknowledged that as insanity is often the consequence of
over-indulgence, as well as of a system of tyranny, while under parental
care, that therefore both extremes are to be, not only avoided, but their
effects counteracted by a judicious and curative system of treatment, and
that this will require to be varied according to the peculiarities of
each individual case.
A private establishment, where cure and reformation are thus conjoined,
becomes an interesting little world of its own. Though to live in this
world is a life of ceaseless anxiety, there is such a perpetual
succession of such an endless and inconceivable variety of strange
incidents and speeches, odd displays of feelings and manners, inside
views of the human heart, and, as it were, of the invisible world, that
the charms of novelty, the excitements of wonder, the enquiries of
reason, and the demands of sympathy, keep the mind so alive, that I have
often observed that the revolutions of the sun seem to run their course
more rapidly now, than before I lived among them. And though the feeling
of being excluded from rational society, often presents itself to the
mind as a terrible sacrifice to those whose earliest and fondest wish was
to live in the sphere of intellect and genius, yet we are often reminded
that they are not always irrational, that some, are so only on a single
point, while on every other they possess more than common powers of
pleasing; others, are in a state of convalescence, and many of them are,
for a while at least, grateful and amiable in the extreme; and it is
delightful to see those who awake from a lost or raving state, as from a
sound sleep or a disturbed dream, with all the freshness of joyous
gratitude and celestial ecstacy, on suddenly beholding a new world of
mind and matter bursting upon them. So that if we cannot always exist in
an intellectual sphere, we are seldom without that of affection and
gratitude; and though it is difficult to prevent, in such scenes as must
often assail us, occasional paroxysms of discontent and wearisomeness
coming over us, they seldom last long, and they are sometimes cured, as
well as brought on, by an occasional peep into the motley world.
Shut out from the world, one is as apt at one time, on again entering
into it, to be as much oversurprised and delighted with the blessed
fire-side scenes where the wise and good man resides, as one is at
another time to be equally over-disappointed and revolted with the
follies and miseries of the moral insanities which exist unrestrained
among men in real life. Nor do I conceive we have more appalling
consequences of disobedience to the natural and divine laws of our being,
in this place, than can be seen in the world, walking in wantonness in
the broad light of the noon-day sun.
Insanity is, no doubt, a terrible visitation, but why should we allow a
false and unreasonable horror to increase it, and why should we thus
sever our sympathy from a disease which more than any other requires it?
The medicinal virtues of the fruits of charity are best proved amongst
them. Grant that the disease arises from some remote or proximate
ill-directed mental states. Why should we have more horror of insanity,
than many other consequences of ill-regulated minds.—To me, the foul ward
of some large public Hospital, is incomparably more horrible and
loathsome.—Such direct consequences of wickedness present the object
before us in an aspect that makes it difficult for us to exercise any
feelings of commiseration towards them. Not so the insane! but these are
views, however, into the consideration of which, I shall not enter in
this place; but I mention or rather hint at the diseases of other organs,
for the purpose of asserting that the reality and appearance of the
miserable state of the insane is not so shocking as people imagine, but
that still I allow it is an awful visitation.
But while I allow this, it is at the same time the strongest reason why
we should be anxious to remove all those false and unreasonable horrors,
which can only aggravate the calamity, by giving countenance to the
imaginary necessity of having recourse to harsh measures,—one ceases with
the other,—it will not only do this, but it will also, I repeat, remove
those depressing feelings of degradation which, whenever reason gleams,
is death to their hopes, and which often prevents their recovery, brings
on relapses, and is the most painful and heartrending feeling they have
to contend against in the critical and incipient stage of their
convalescence.
By this system of greater liberality, it would soon be found, that
patients would no longer consist of violent and extreme cases alone, but
that every thing repulsive in their present state and aspect would
quickly disappear, their whole character assume a milder form in reality
as well as in appearance.—Indeed, this is already the case. All things
are improved. Thus popular prejudice ought to cease, and a more
favourable prepossession should occupy its place; and the world being
fully persuaded, that there is much more to hope than to fear from a
residence at such a place, persons at the commencement of the malady are
easily induced to enter them of their own accord, or are sent by their
friends without delay or reluctance, before the disease has passed the
curable stage. “Cases,” as a friend of mine justly observes, “were this
feeling fully established, would be relieved without proceeding to the
utmost degree of severity; and we might confidently anticipate that when
the decided excellence of such a system, as regards moral, intellectual,
and physical management, is adequately understood, the premonitory
symptoms, often slight and various, but generally significant, will no
longer be disregarded: and incipient mental disease, arrested by the
judicious means there pursued, will not be allowed to assume a form and
magnitude constituting the most awful calamity to which man is subject:”
and why should it be allowed to do so, when it may be asserted, without
contradiction, that functional disorders of the brain, are less liable to
end in disorganization, and possess a greater power of readjustment, than
any other part of the human system—woe unto us if it were not so.
The advantages which may arise from this system will appear in a still
more striking point of view, when we reflect that those cases which
without proper care in the early stages of the disease ultimately become
the worst and the most dangerous, are precisely those which are fatally
neglected, in the first instance, and which are scarcely ever placed
under any medical treatment or moral discipline until the evil is past
all remedy. Cases of suspension and cases of gradual decay of mind, as
well as cases of Hypochondria, are of this description. I had lately
applications to receive three patients of the latter description, all of
whom committed suicide during the delay between the application and the
intended removal.
It is true, there are cases, which require a very delicate, and
conditional sort of superintendance, and that harsh measures and
indiscriminate treatment would, in many instances, be more injurious than
even absolute neglect; but at the same time, it must be observed, that
such persons generally require to be placed under some judicious and
delicate restraint, from the fact that their vicious inclination (for in
these cases the disease begins in chronic inflammation and ultimately
softening of the cerebellum) leading them into vicious habits, would
rapidly accelerate the disease and make it a confirmed and incurable
case. I have had some cases of gradual decay of mind, which, if not
curable, might, with care, have continued for years in a tolerable state,
but when allowed their liberty only for one week, they so accelerated the
progress of the disease by dissipation and excess, that they suddenly
sank into hopeless idiotcy.
I have known several such cases, who were never under any care, but left
wholly to themselves, sink as suddenly into the same hopeless
state.—Cases of Melancholia and Suicide, are often unsafe; the first is
not a less decided case, though less avowed and acknowledged inclination
to suicide; the other, though avowed will often pretend to be much
better; sometimes even strongly confess their guilt in having allowed
themselves to indulge in so dreadful a propensity; and all this, merely
for the purpose of throwing their friends off their guard; when, the
moment they suspend their vigilance, the suicide seizes with avidity
whatever means or opportunity may be presented to him, to terminate his
present miserable state of existence.
It is evident that to pursue this system, it will require great anxiety
and vigilance, and that we must not care for labour or sacrifices but
seek to do good for the sake of the good to be done; and when this is the
case, we shall be most desirous thoroughly to understand every form and
species of the disease, for we shall then know that it requires that we
should, with the utmost nicety be able to discriminate between the
different forms and species of insanity, in order that we may discover,
prescribe, superintend, or enforce the peculiar treatment which each case
requires.
These conditional plans of superintendance must be allowed the widest
range, a range which no inexperienced person, still less those who have
false notions and impressions of the general character of the insane, can
possibly imagine, and for which no acts or rules can give directions—How
then can those without knowledge and experience pretend to undertake such
a charge? Often we have only a choice of evils; and we must be less
anxious about the risk of accidents, our own credit, or interest, than
the cure or chances of good to be done. In some cases absolute
confinement would rapidly make the patient’s state worse, and we must
give either real or apparent liberty; a liberty which some would think
imprudent. {95}—Yet I believe it is a fact, that there are the fewest
accidents where to appearance the greatest liberty is given, {96} harsh
measures always increase the evils which they would pretend to cure; but
should one accident occur under this mild system, the person adopting it
would be more blamed than he who had twenty accidents on the old
plan.—With the first system, it is often difficult to persuade the
friends of the patients to concur and co-operate.—The family dispositions
often render this probable; nor can we always blame them: but he who
undertakes this charge, while he endeavours to persuade and conciliate as
far as possible, must in many cases feel himself called upon to act with
decision.—If he adopts the fears and prejudices of others, then his
system will become one of duplicity and tyranny, exciting suspicion and
vindictiveness, destructive alike of all confidence and chance of cure;
for unless we acquire the confidence of the patient, no good can be done;
mutual distrust will end in absolute slavery and restraint to the
patient, and in the baneful habit of exercising the love of power on the
part of those who have the superintendance.—Hence the evils apprehended
by their friends as likely to arise out of the patient’s vindictive
state, will be most effectually established and increased. Instead of
the calming effects of a system of confidence and liberty, tranquillity,
and peace, this contrary system will continue to goad, irritate, and
inflame that part of the brain through which the mind, in this state, is
operating; and in pursuing such a course we are clearly guilty of making
that become fixed and permanent which otherwise might only have been of
very temporary duration.
While nothing is more certain than that, _in most_ cases, too sudden a
return to old scenes and associations is extremely dangerous, there are
some others where I have known their returning home at an early period,
or even at some critical point of convalescence, decidedly expedite and
confirm their cure:—when there appear evident reasons to augur favourably
of such a change, the trial should be made—we have only a choice of
evils, and we must endeavour to choose the least.
It is remarkable, that many have, in an incipient state of convalescence,
been placed on parole of honor; first, they are simply restricted to the
garden, and afterwards the fields; and if no breach of confidence occurs,
they are allowed a pass key to go out and in when they please; and
scarcely an instance has occurred in which they have taken advantage of
this privilege to make their escape;—nor have they opened the doors to
others.—Those who escape are always those who are not so trusted.
In some cases, I have known the convalescence of patients confirmed, not
merely by placing them on their parole of honor, but by discharging them
as patients, and inviting them to remain and consider themselves as
voluntary visitors.
It is astonishing what a stimulus all this is to others to exert their
SELF-CONTROL, and to behave more correctly; and still more so, on
promising that on their continuing correct for a given length of time,
they shall have these indulgences. But all this shall be more minutely
detailed under the Essay, _Moral Treatment_; when I shall state the
effects produced by always treating them as rational beings, and allowing
them, in proportion as they conduct themselves more rationally, to have
the privileges of, and as far as possible to associate with, those who
are so.—The efforts which (in consequence of this principle being
observed in all our conduct towards them,) they constantly and anxiously
make to be considered rational, is an acquisition of prodigious moment
and when we see they possess it, we may pronounce it an excellent symptom
of the returning control of the will and understanding.
This is in perfect accordance with the principle which stimulates men, in
society, to the useful or baneful exercise of their understandings; and
where it exists not, the mind will rapidly sink into a state of apathy
and indifference, {99a} and I have no doubt, that many an insane patient
who feels that he no longer possesses this stimulus to mental exertion
and control, gives way to his foolish thoughts, and still more so, when
he finds it more easy to give pleasure to others by their utterance than
by endeavouring to talk rationally: thus he acquires the habit of talking
nonsense, and hence this constitutes the character of many of the old
insane, who might, I believe, have otherwise been brought into a more
rational state. {99b}
We should never for our own ease encourage their delusions, but tell them
(when we do notice them at all, for silence is often the most effectual
reproof we can give; but when we are obliged to notice them, we must
honestly, but with charity, tell them) what is false and dangerous, and
which often has a good effect; and if it does not cure, it restrains them
from talking on the subject of their delusions.
Many instances of cures on this principle are recorded, and many more of
my own I shall have to state when I come to Moral Treatment.
Nothing can be worse than the common practice in public institutions of
allowing idle visitors to amuse themselves by listening to, and of course
encouraging, their conversation on the subject of their individual
insanity.—When we do notice these delusions, and it must be seldom, it
must be a very important and grave matter; and we must exert all our
eloquence, and call forth the most overpowering arguments against the
folly, wickedness and direful consequences of encouraging these
delusions.
Dr. Crowther says, “Mad persons are frequently capable of being reasoned
with; and it is sometimes in the power of the physician to remove false
impressions from the patient’s mind, by a well-directed reply and
judicious reasoning.”
Another patient imagined himself to be Jesus Christ; and in proof of it
showed me a scar he had in his side, which, he said, had been occasioned
by his having been pierced with a spear.—I remonstrated with him on his
assertion, and remarked that our Saviour was wounded on the side opposite
to that be had indicated as the part wounded in himself.—Convinced, and
apparently ashamed at the consciousness of the fallacy of his own
reasoning, the patient recoiled, hid himself under the bed clothes, and
never reverted to the impression under which he had previously laboured.
In many points the insane are accessible to reason; and at all times and
in all cases, as a rule, they should be treated as if they were still
reasonable beings.—Many are able to detect ignorance, and can appreciate
and respect knowledge: convicted ignorance in a superintendent is fatal
to his influence and authority. To have the character of being
intelligent, is of great service.—Nothing impresses them with this
conviction so much, as proofs that you possess a key to unlock their
minds—that you have a perfect insight into the peculiarities of each—can
trace to its origin their insane state,—the evil of extremes,—and more
especially can meet these with clear views of the truth of that which
they have perverted.—But all this still more requires that you are not
merely esteemed for talents, but also for goodness; then will your
arguments and example be like oil on the stormy waves, calming turbulence
and breathing peace even upon the victims of passion, misery, and
distraction.
All this will be acknowledged to be of great importance, when it is
considered that to call forth the exercise of self-control is the most
powerful moral means of recovering the lost equipoise of mind. And that
this may be done, is certain, for many have some power of self-control
remaining, but self-control in a state of misdirection. Numbers also
have many avenues of the mind still open, through which the understanding
may be stimulated into active exercise, and the will turned into a right
direction; and thus the same principle may in many cases ultimately
become the means of promoting their restoration.
They generally know the points which others consider as proofs of their
insanity, and they should be made ashamed to display them, but never
directly irritated by a domineering opposition, which would only rouse
the bad passions and the spirit of self-will to resist all means of
counteraction. {102}—Hence where these rules are observed, it is often
perceived that they will, on their first entrance, keep their delusions
out of sight; so much so, that it is often for awhile difficult to
discover their insanity.—The early prospect also of their liberation
often induces this concealment: we must encourage this, but at the same
time, they should see that we have the power to perceive when it is real,
and when it is feigned for this purpose. When they know we judge from
the state of the inner, and not the outward, man, the effect is
wonderful.
It is not by any system of fear, as was once imagined, that all this is
to be done. This is a restraining power, which must be seldom resorted
to, and then only for specific and temporary purposes, and never of long
duration, otherwise the mind will be thrown on itself, and feed on its
notions. It should never be used except conjoined with the suspension
and loss of sympathy which they have felt valuable, or for the sake of
others whose comforts are not to be sacrificed merely that they may
selfishly indulge in their absurd whims, and annoying conduct, or in
their erroneous views and vicious propensities: for these reasons and
purposes they must be separated, and if not corrected by occasional
separation, then they must be classed with those whose comfort they
cannot derange. They must feel all this as the effect of their conduct,
and that their treatment depends on their behaviour; but any discipline
or change must never be made without a self-evident cause, and never in
the doing carry the air of tyranny, passion, or injustice.
All the principles applicable to the management of children, are equally
applicable to them. Though we must watch every probable and threatening
storm, we must not too eagerly anticipate its approach—we must wait until
it breaks out and gives us an opportunity to justify the moral measures
we conceive are best calculated to produce a beneficial influence.
As I have shown, we always endeavour most sedulously (especially in the
first instance begin with) to act on this principle. We treat nearly all
on their arrival as if they came merely as visitors, and never alter our
conduct until they cease to behave as other people; and then they cannot
but blame themselves for their confinement or any change of treatment
that their conduct renders necessary, and which must therefore be always
sufficiently gross, even in their own estimation, to justify the change.
As classification must be based on these moral views, there is
necessarily included in this Essay much that will fail to be more
minutely considered under the Essay, Moral Treatment, and much more that,
it may at present appear, I have, altogether omitted—such as the obvious
necessity of separating the vociferous, the dirty, the epileptic, &c.
from the more rational, delicate, and nervous.
One principle is very important, hereafter to be enforced, which is, that
some must be classed so that bad habits may be prevented by the constant
presence of others to call forth the sense of shame to restrain them.
In fact, this plan of treatment should embrace every means conducive to
the cure of its objects, such as domestic quiet, and the removal of every
possible annoyance; and we are, above all things, carefully to avoid
every appearance of restraint, and to adopt as little of the reality as
is compatible with the security of the violent, dangerous, and
discontented, who must be restrained, and if possible, without exciting
or increasing their diseased state. We must do every thing we can to
soothe and comfort the disappointed and melancholy, and diligently labour
to heal the broken-hearted; we must ascertain causes and effects, and
remove or counteract them; we must strive to correct or cure wrong
notions and impressions; we must cultivate and strengthen better feelings
and principles, and discourage all that is bad, or allow it to die away
for want of nourishment and exercise: for such purposes the
superintendant must be armed with medical and moral means at all points,
and be above selfish considerations. To describe all this in detail,
would be to write volumes. It is evident then, that every variety of
suitable treatment should be adopted, according to the nature and
circumstances of the case.
All this is not to be done by mechanism, nor by the strictest attention
to any plan which some cold rules prescribe. Acts of Parliament can
never make these places what they ought to be, and which it is of the
first importance they should be; I mean places for the voluntary
seclusion of an exhausted mind, or nervous invalid, and in every case as
institutions not so much for the confinement, as for the cure, of the
insane.
Acts of Legislation may interfere with, cramp, or destroy the heaven-born
and heaven-directed energies of the mind.—It is dreadful to paralyze or
destroy the spirit of kindness, guided by experience and wisdom, by
confining it to rules which have merely for their object the prevention
of evil, and not the production of good! Those who legislate, should be
careful not to meddle in the province out of the reach of human
interference. By so doing, they may destroy, but they can never give,
the spirit by which alone good can be done.
The present system adds to the horrid association of these houses, (and
for which some of these houses may be accused of all the blame,) and
prevents them from becoming what I conceive would be of the first
importance,—I mean places for the voluntary seclusion of an exhausted
mind, or of a nervous invalid, which would be of the first advantage to
them, and would besides take away the feeling of horror associated with
such houses. It is so in France. On the same principle, those who are
sent without their own concurrence, should never be treated as if they
were insane; the names “Asylum,” “Patient,” “Keeper,” “Insanity,” should
never be heard among them; many have been made worse by a contrary system
of treatment; and I may also mention that I am more and more convinced of
the necessity and efficacy of proper medical aid, and of course of a
medical man, or of one having acquired medical experience, being amongst
them,—I repeat “that no man ought to keep a house for the care of the
Insane, who does not make cure his ruling motive for receiving,
detaining, or discharging patients from his house.”
Again, the arguments are endless to prove every thing should be done not
to _increase_, _but diminish_, _the horror_ associated with these places.
No act of Parliament can give knowledge and principle, and good feelings;
and no Act should be made as a substitute for knowledge and principle and
good feelings, which every one in his specific sphere should possess. No
Act can give knowledge and principle, but an Act can carry with it so
much opprobrium, that men of feeling and knowledge and principle, are
deterred from undertaking a department of the profession, which the law
supposes is only in the hands of base, unprincipled men. The aim of the
Legislature should be, to add to its respectability, and to offer
encouragement to those persons who possess that knowledge and principle
and have it in effectual operation.
Mankind in general, are not made better by treatment that shows our want
of confidence in them. Though the mild system is universally allowed to
be, not only the most judicious, but that which ought exclusively to be
adopted, it will be seen that it may be carried further than it has
hitherto been done, and much greater latitude given than we have yet
conceived possible, and all this with the best possible results.
The principles of human nature, its moral and physical laws, are
illustrated among the insane, as well as sane; and if revolutions and
abuses of liberty in the world are the unrestrained re-actions of the
spirit of justice in men, against those who have neglected or improperly
restrained them; so, in lunatic asylums, improper conduct towards the
insane, or too much restraint, has given rise to much of the misdirection
and irregularity in the display of their animal spirits; and be it
observed, that here, as well as in the world, those men are the first to
blame effects which they either themselves caused, or which it was their
province to foresee, prevent, or cure.
When the understanding is enlightened, or the higher feelings cultivated,
the impulses of our inferior feelings will assume a better character, and
be less liable to abuse. In asylums, whatever mischief and malignity,
are, by improper treatment produced, the attendants place the whole to
the account of their insanity; very readily, and without any
self-accusation, blaming, and perhaps, severely punishing effects which
they themselves have either been the sole cause of, or which they might
have prevented. Nor can we wonder that such evils have existed, if we
consider how very difficult it is, to find combined kindness,
understanding, and practical usefulness in those who can be procured to
attend upon them. Yet all this should exist in the character and conduct
of those who undertake their management.
The grand principle of treatment is, to avoid even the appearance of
unnecessary restraint, and to treat them with apparent confidence: such a
plan of procedure will almost invariably excite their secret but proudest
endeavours to preserve and retain this confidence. There is a secret
power which holds the helm of the mind, and by its controlling and moral
influence guides it more effectually than any rude restraints applied to
the bones and muscles of the human frame.
There is no influence so powerful as the sphere of a moral influence.
It is painful to reflect on their former treatment; caged in
iron-gratings and exhibited for money! Treated as wild beasts, they
necessarily became like them, or worse! Devils in revenge and evil,
Satans in deceit and delusion! Or if any portion of the man remained,
think of the spirit writhing in agony, or sinking with despair within
them! All this, and worse, in some despotic countries, even now exists;
and in how many places are they not still made to drink the bitter cup of
neglect and coldness, contempt and cruelty. Where do they receive, as
they ought, judiciously and constantly, the cordial of sympathy and
friendship? Where is every appearance of confinement and injurious
association carefully avoided, and every thing studied to make them feel
at home, and all this combined with medical attendance? Say not all this
is unnecessary; for if life, under any circumstances, cannot be said to
exist without some association of sympathy, it is certain there are among
the insane, cases of misery and wretchedness which absolutely require for
their cure, as well as their comfort, all the moral kindness and medical
attention we can possibly give them.
It has been an universal complaint, that there is nothing certain or
fixed in the treatment of Insanity, and that it is presumed it is not yet
fully understood. I am of opinion that no medical treatment in any case
can be fixed as certain or judicious unless we understood the origin and
nature of disease; and I have therefore devoted a considerable portion of
this Essay to the consideration of the correspondence which exists
between the causes and effects produced; and this I only consider as
preliminary to a more full and adequate investigation of causes than I am
aware has hitherto been made; but still, as preliminary to this important
subject, I shall, in my next Essay, first give a general explanation of
the origin and cause of disease, and this in agreement with a principle
which I conceive to be of universal application.
APPENDIX
TO THE
ESSAY ON CLASSIFICATION.
INTRODUCTORY OBSERVATIONS.
As in the foregoing Essay on Classification, I have several times stated
my objections against writers on Insanity selecting only extreme cases,
by which, I conceive, impressions of horror against the Insane are
increased to their prejudice; I shall, therefore, for the _express
purpose of exhibiting a fair specimen_ of the general character of the
insane collectively, in their worst and most revolting state, add, in an
Appendix to this Essay, about twenty of the oldest in age as well as in
the duration of the disease, and of course of the most incurable cases,
taken in regular rotation from the Register Book of the oldest Asylum in
the kingdom, excepting Bedlam; containing, at the time the living
characters were described, about one hundred of the same class. Now
though these are taken from among those who had suffered all the
brutalizing influence of the old and neglected system of treatment, yet
they do not, as a whole, exhibit so shocking a picture as previous
popular prejudice would imagine. Notwithstanding this truth, it is
proper to state, that they are incomparably a worse picture, than the
same number would make, taken with equal fidelity and correctness, from
among my own patients, admitted within the period of my own exclusive
superintendance,—this would, therefore, be much better calculated to
correct this injurious prejudice than that which I _now_ give for this
purpose: but they are too recent to be so introduced; yet as this would
be a very striking contrast illustrating the effects of different
treatment, I shall be prepared, should I live long enough for time to
throw his dark veil over their memory, with the same number of cases,
taken and described on the same principle.
I am the more anxious to do this at present, and fulfil this my future
intention, because it may perhaps be laid to my charge, that in adducing
cases illustrative of the principles contained in this Essay on
Classification, as well as those which, from similar reasons, I may have
hereafter to introduce, that I have been guilty, and may be guilty of the
same error of selecting peculiar and extreme cases for my purpose; but I
have been led into this, from the feeling that circumstances had forced
upon me, however contrary to my previous intentions, something of a
defensive attitude.
These are the reasons which have been my inducements in adding this
Appendix; at the same time, to make the cases, in this naked form, as
interesting and as useful as possible, I have not only drawn them with
the most minute attention to truth, but to each I have appended some
appropriate and useful observation.
Previous, then, to my entering upon the important subject mentioned at
the end of this Essay, I shall now introduce these cases as a faithful
portraiture of the Insane.
_No._ 1.—_Admitted_ 1782; _aged_ 76.
THERE is nothing recorded of this case, from which any correct
information of the causes of the malady, or of its nature, when admitted,
or of its progress since that period, can be drawn. Some of his
relations are insane, and many of them exceedingly eccentric. His
friends accuse some nurse of an improper application for the itch; yet,
notwithstanding this accusation, the disease was gradual in its approach.
He was gay when at Cambridge, and lost considerable sums at the gaming
table. There is reason to believe that he had always been eccentric; and
I have been told, that in his youth, he was proverbially called the proud
and polite man. {114a} Whether this be correct or not, it is certain,
that even now, though so little mind remains, he is soonest roused and
offended, though otherwise very good-natured, by whatever questions his
own importance.
Though, like many old men, he is fond of dozing away his time in bed, he
has, notwithstanding, seasons of greater animation, when he seems more
busily occupied with his own thoughts, often talking to himself;
repeating very correctly passages committed to memory, probably forty
years ago. {114b}
At these periods, unless teased or vexed in the way already stated, he is
very good-natured and polite; and from his general manners, and
particularly in the modulation of his voice, he still appears, in spite
of the coarseness of his dress, {114c} the remains of a perfect
gentleman. At these times, he is, for the most part, very happy,
laughing and playing like a little child; and his very mischievous
tricks—throwing stones, writing on the walls, tearing his clothes in
order to make some little fanciful change and decoration of his dress,
seem to be done rather as resources for regular employment or amusement,
than from any malicious design or delight to be mischievous.
OBSERVATION I.
The slight changes or states of excitement described in this case, are in
my opinion, the mere fluctuation of his animal spirits. I shall
hereafter make further remarks (see ob. 5) on this subject; and
therefore, in the mean time, (to obviate the objections which may be
brought against this view,) I shall only observe that when we consider
the defective and uncontrolled state of mind, {115} in these old and
incurable cases of insanity, any change or increase of their animal
spirits must, though perhaps depending on causes which equally affect the
sane, display itself in them, in a very different manner.
_No._ 2.—_Admitted_ 1785; _aged_ 67.
There is no statement of this case on record, from which any satisfactory
information can be derived; nor have I been able to obtain any account of
his former life, or the nature or treatment of his case. There has been
nothing of late years to distinguish his case from many old ones, whose
minds have sunk into the torpid state, except it be, which is scarcely
worthy of notice, that he has sometimes stood on his head to say his
prayers; sometimes spit in his pocket; and, when provoked, used indecent
language; otherwise his state of mind has not, for many years, exhibited
any observable alteration. {116} He will be best known when I say, that
he is singled out from the rest, as a little, timid, old-looking man,
uniformly sitting in a moping, creeping posture.
[Picture: No. 2 page 116]
OBSERVATION II.
This man is not more of an idiot than the one just described, yet there
is much less appearance of mind about him; but his mental powers had not
formerly been so much evolved and improved by education; and the mind,
like the soil we tread on, once properly broken up and cultivated, will,
in defiance of neglect, long retain traces of its former improved state.
Besides his want of early culture, being one of the middle class of
patients, he was wholly left without mental food or exercise. There was,
under the old system, a complete sacrifice of the lowest, utter neglect
of the middle, for the sake of the higher class of patients; so that
there was, with the middle class, for the most part, no intellectual
interest excited by social converse and attention; nor, on the other
hand, were the malignant passions kept alive by brutal treatment: and
hence we now find amongst this class, the greatest proportion {117} of
those whose minds have sunk into torpid inactivity; and not so much
because they are lost, but because, from their want of excitement, they
have too long continued in this motionless state. It is true, that their
minds may, by the first attack, have undergone some great shock, to
derange or paralyse the more perfect performance of its functions; but it
is certain, that afterwards, no means were used to resuscitate or feed
the powers of the mind into renewed vigour and activity. Few, even in
the perfect possession of their faculties, could bear to be excluded from
the air and sunshine of social life, and mingle only with beings in this
melancholy state, without feeling its effects upon them. We are not to
wonder, then, that those whose spirits have thus been prematurely
entombed within them, should have become almost as dead to themselves and
the world, as if the soul had already left them. To prevent these
consequences, I shall state all that I think ought to be done, in another
number of this work; which I conceive is the most interesting part in the
treatment of insanity.
_No._ 3.—_Admitted_ 1787.
There is nothing on record about this case, nor have I been able to
obtain any information of his previous history.
His mind is not in so defective or deranged a state, as strangers and
superficial observers are, from appearances, apt to imagine. It is true,
he seems stupid and churlish, always silent unless spoken to, and then he
answers with abruptness and impatience, in a murmuring, grumbling, and
almost unintelligible manner, putting his words oddly together, like a
child, or one unused, or too lazy, to articulate, and not that his
answers are absolutely irrational.
[Picture: No. 3 page 118]
He plays well at draughts and whist, but his doing so appears to depend
more on old habits, {119a} than on the present exercise of his faculties;
which, though, as already observed, they are not wholly lost, yet, from
his torpor, age, and the natural obstinacy of his disposition, he is
disinclined to exert himself out of his usual course: and though his
constant habits of employment and amusement in the house, make up for him
a considerable stock of felicity, and aid in procuring the degree of
health and spirits he enjoys, and the degree of mind he still possesses;
yet he is so extremely obstinate and tenacious of his own mode of
procedure, that any attempts to oppose him, will arouse his temper into
fits of angry passion. {119b}
OBSERVATION III.
There is nothing particular to observe here, unless it be the obvious
remark, that from his age and confinement for such a number of years,
among beings who, for the most part, have no commerce with right feelings
and thoughts, it is wonderful that any thing like powers of mind should
still remain; or that he should, excluded from the excitement and
collision of the world, possess any inclination to exercise them; but
this is most probably owing to the amusements and employments already
stated; and for the sake of drawing attention to this fact, have I been
induced to make any observation on this case.
_No._ 4.—_Admitted_ 1787.
There is no statement of this case on record; but I have been informed,
it was the consequence of injury on the head. He is a hopeless, and the
most striking, case of idiotcy, at present in the house: a poor, simple,
innocent, dangling, pouting, starved-looking creature, with a bluish red
nose, and his head hanging forwards, saliva running over his falling
lip—generally moving about to gratify his childish curiosity. Yet, as
little mind as there is about him, still even he has fluctuations of the
animal spirits: sometimes he is depressed and miserable; at other times
he is animated and happy. When depressed, he for the most part repeats,
in a feeble, plaintive tone,—“poor creature.” When animated and happy,
he will throw his arms about in a most laughable manner, to the great
amusement of other patients; so much so, that it is impossible to convey
any conception of it, unless it be by making an old person try to imitate
the frisky movements of an infant’s arms. These exhibitions are of rare
occurrence. He will mumble over a tune very correctly, {121a} but has
seldom any words. He is pleased with striking objects, particularly such
as have glaring colours about them; and women, or their dress, arrest his
attention. {121b}
[Picture: No. 4 page 120]
_No._ 5.—_Admitted_ 1791.
There is likewise no statement of this case on record, from which any
satisfactory information can be drawn.
His personal appearance, and moping manners, were so very like the case
described, No. 2, that it was common for those in the house to mistake
the one for the other. He, like many other old and incurable cases, sat
in a solitary, half-dozing state, his head reclining against the
fire-guard, and seemed, when roused, like one who wakened out of his
sleep unrefreshed. He was most remarkable for his extreme good nature,
and excellent disposition. {122a} When on his death-bed, his gratitude
and affection to his attendant (who was certainly an excellent nurse)
were very pleasing. He had been long sinking from disease of the lungs,
constantly coughing and spitting; and, latterly, purulent matter, in a
very great quantity. He died on the 13th April, 1822.
_No._ 6.—_Admitted_ 1791.
There is no statement of his case, and I have not been able to collect
much information about him. It is said, he received a severe wound, and
the mark remains on the upper back part of his head. {122b} Report says,
that he fancied himself in love with a farmer’s daughter, and walked
whole nights before her father’s door, without the slightest previous
acquaintance with the object of his choice. This would seem rather the
effect than the cause—a common mistake; they are constantly confounded
together, or mistaken for each other. It is certain, that his neighbours
were obliged to send him to a place of confinement, for this
reason—whenever he saw any cattle in a poor pasture, he, from the impulse
of his nature, invariably removed them into a better.
[Picture: No. 6 page 122]
He is well known through the house, and even through the town; and on
this account, I feel some hesitation and difficulty in attempting to
describe his case.
He is a general favourite, and every one meets him, and he meets every
one, with a welcome, good-natured smile, and he appears so much pleased
to entertain them with some extraordinary ridiculous tale, that a
stranger would suppose he talked absurdly, on purpose to amuse him. {123}
Notwithstanding all his talk, he is most industrious, and the most useful
man in the house; does his work most correctly and systematically;
delights in going upon errands amongst his acquaintances in town, always
delivering the messages properly; and the moment he has done so, begins
with his own strange nonsense, to the great delight of his hearers. His
spirits are always even, he has regular exercise, and his good nature is
proverbial; nothing vexes him, unless it be, threatening that another
shall be employed instead of him, to do the work he has been in the habit
of doing for his favourites in the house.—His delight is, night or day,
to be of service to others, so that his energies are wholly and regularly
expended in being useful, making himself happy, and pleasing all who come
near him.
OBSERVATION IV.
Probably his astonishing correctness in delivering messages, &c., in the
midst of so much apparent confusion of mind, may be thus explained:—From
the pre-eminence of his good nature, the desire to please still retains
some hold over the rest of his faculties, and, perhaps, also over the
extreme extravagance of his conversation, which may arise from the same
cause. We have only to imagine, that his erroneous tales were, in the
first instance, listened to (a fact, this, of injudicious treatment,
which is too common,) with seeming assent and delight, until he found,
from daily experience, that to please others, he had only to encourage
his foolish thoughts, and utter them, and then the habit would insensibly
grow upon him, until it became inveterate; and hence is explained another
singularity about him,—that in his present manner of talking, it appears
as if he were talking absurdly for the very purpose of amusing others.
It is now, however, certain, that it would be not only useless, but
cruel, to try, by direct means, to prevent it. Yet, though we are not to
tease and vex him, by contradiction, or by refusing to listen to his
tales; it ought to be remembered, that in this and all other cases, we
ought never, on any account, to violate the truth.
Though we should never forget to exercise prudence, we must be careful
that truth still presides at the helm, otherwise it may degenerate into
cunning; then what we call prudence, is vicious and mischievous; and yet,
men persuade themselves while doing so, that some evil is avoided, or
some good is secured. No power of the mind should ever be so exercised,
as to require the suspension or sacrifice of another. To exercise every
virtue in its place, and to give to each “its relative and appropriate
share,” is the perfection at which we should ever aim. This principle,
as it is the best prevention, so also it is the best remedy in the cure,
of insanity.
_No._ 7.—_Admitted_ 1792.
No statement of this case, from which any information can be drawn: it
is, however, certain, that insanity is in the family.
Among the old cases, we have none that arrests the attention of strangers
so much as this, and he never fails to attract the gaze of idle
curiosity. His habits of circumgyration, with sudden stops and
starts,—his strange air of abstractedness, a sort of excogitative look,
apparently puzzled to find something out,—odd way of talking to himself,
as if he himself were some other person, saying, “what a noise the fellow
makes,” “I think the fellow’s a fool,” and striking his face in apparent
anger,—strange mode of mentioning names once familiar to him,—putting a
question,—seeming to listen, and giving an answer quite foreign to it,
are most striking, and such as no descriptive powers can enable another
to conceive, without seeing him. When noticed or teased, and sometimes
without, he strikes and scratches, in a way that would seem either like a
bad habit that had been taught him; or half frolic and half mischief, and
which, by provocation, becomes more serious; otherwise, he is sensible of
kind treatment; and now, from increasing age, and perhaps from being, on
the whole, less teased, he exhibits less of this disposition. This state
of continued exertion and restlessness, is followed by a proportional
degree of depression, and, after being recruited by sleep, returns.
These regular alternate states of excitement and restlessness, of
depression and sleep, last each for several days, and this for many
years’ duration. When most excited, he makes a strange loud singing
noise, stamps with his feet, strikes his head and face, and exhibits
various incommunicable indications of surprise, pleasure, or anger, just
as his mind happens to be agitated, like one in a dream, with the
floating and shattered images of times gone by, passing confusedly
through his mind.
OBSERVATION V.
I am unable to ascertain, from any traditionary treatment of this case,
whether the habit of gyration originated in some diseased imagination; or
was merely, as I believe is more frequently the case, a habit which he
had acquired from long confinement in a small space. This habit was
common in former times, when they were confined in cells, and had no
airing grounds; and yet some writers, without attending to this
circumstance, have called it a symptom common to insanity! in this way,
many things have been called symptoms, which have been, in fact,
indications of improper treatment. The peculiar states of excitement and
depression, so striking in this case, and which is so common with the old
insane, as to have been called the chronic type of the incurable, I shall
endeavour to show, how, in many instances, it may be explained on a
different principle.
Dr. Halloran, in his practical observations on Insanity, says,—“Chronic
insanity is that form of the disease, which, having passed through the
acute and convalescent stages, has assumed the more permanent character,
and is known by the frequent exacerbation of the original accession;
also, finally, under circumstances of less violence, and with symptoms
subacute in relation to the primary affection.” He adds,—“There are few
Practioners of the most ordinary discernment, who will not feel
themselves disposed to acknowledge that cases of insanity, precisely of
this form, compose the greater majority of those committed to their
care.” He further says,—“That these paroxysms are for the most part
periodical in their approach; for though of shorter duration, they
continue pertinaciously unyielding.”
From the observations which I have to suggest, it will be seen, that I
conceive in some instances, in opposition to Dr. Halloran, and some
others, that the chronic type, or the paroxysms of some of the
permanently insane, are merely an exhibition of the irregular increase in
the stock of their animal spirits, and not an exacerbation or new
accession of the disease: and that even, in many cases, where the
alternating changes of excitement and depression are most striking, I
believe they first originated in those fluctuations of the animal
spirits, common to all of us; in some instances, it is true, (and the
case last described is one,) singularly modified, not merely by the state
of mental alienation, but by circumstances connected with their
confinement. Before, however, I endeavour to explain these singular
modifications, it appears necessary to premise some observations on one
of the causes which conspires to produce them, which cause is connected
with the atmosphere.
But as I intend to devote an Essay on Atmospheric influence, I shall
content myself with asserting, in the mean time, that there is some
common cause, or causes, assigned either to atmospherical changes, or
co-ordinate with these changes, affecting the animal spirits of the sane
and the insane—of the healthy and diseased, (in all, the manifestation is
according to individual state,) is generally, and indeed, I might perhaps
say, universally admitted, that the fact will require no further proof,
either to introduce or confirm its truth. There is then a certain
periodicity in the excitement and depression of our spirits, as well as
in all our diseases, mental or corporeal, so absolutely certain, that it
must be the conjoined effect of some order in the operations of nature,
and cannot be explained on the principle of accidental or apparent
coincidence, by which credulous and superstitious minds are often
deceived.
Though the artificial habits and constitutions of men must modify these
influences, we still, notwithstanding, often perceive the effects are
simultaneous in time, and sometimes that they preserve the same type, and
as such artificial modifications do not exist in the same degree in the
animal creation, especially in those undomesticated, on the contrary,
these influences are so uniform on them, that the signs and symptoms of
their presence are the barometers of rural life, it follows that these
very modifications in men, when rightly perceived, are additional proofs
of their being the effects of one cause.
Even in man the influence of seasons, climate, and all violent
atmospherical changes, are so striking as to be admitted by all, because
they are so powerful as to overwhelm all artificial counteracting
modifications; but, as it regards all common and minor influences, even
when the effect on the mass are coincident in time, they are in
individuals so modified by the specific habits, the state of the health,
and the peculiar state of mind, that they become so much disguised, and
of course so much less obvious to common observation, that even some
medical men will deny atmospherical influences altogether when held forth
as objects of scientific investigation, and ridicule as fanciful the man
who maintains a firm and well-grounded philosophical faith in them; this
is most inconsistent, and is like admitting a clock may mark hours, but
cannot mark minutes as they pass.—It is the child who has just discovered
the use of the hour, but not of the minute hand, of a time-piece.
The philosopher knows that the unobserved and silent influence is the
most important, and that the striking results are the mere indexes of its
secret movements.
Let ignorance pretend to admire these striking results, and laugh at him
who is anxious to discover the cause which produces them; he has
incomparably more interest and pleasure, his eyes more open, and his
understanding more exercised in these common facts, than other men, while
yet he deems them as nothing compared to the end they serve; they are
indeed interesting in themselves, but to him they are most interesting,
because he considers them the means, but still only as the means, by
which he obtains the noblest object which the light of his reason can
discover—the discovery of those principles, or of that order of operation
of the cause which produces them.
Medical libraries are full of books on the influence of seasons and
climate, miasmata, malaria, and other local causes of disease: and they
admit also that the influences of all these are such, that almost all
diseases common to man will exhibit altered and corresponding symptoms
under these varying circumstances, proving they participate in, and are
conjoined (or “tinged as it were,” as it is said by some,) with them.
All this, however, I leave for the Essay on the Atmosphere, but I mention
these facts and observations in the mean time for the sake of this
argument, that if all these modifications are admitted to exist among the
sane, how much more strikingly must the peculiar circumstances, the
singular habits, and the altered state of mind of the insane, modify the
effects of this influence:—so strikingly, that I have no doubt, from
these causes, may be explained the very singular exhibitions in this
last-mentioned case. Where the particular state of mind, and the
peculiar circumstances connected with his confinement, have superinduced
in the system the irregular accumulation and expenditure of the nervous
energy, so that, though the increase of the animal spirits was, in the
first instance, the common effect of a cause operating in and through
all, every where,—yet, operating through, and modified by, the
peculiarities connected with his case, has in time produced in him, as
well as in a less striking degree in others, and in fact, in many, though
certainly not in all cases of insanity, effects so very singular and
striking.
Again, these changes of the atmosphere, which produce these effects on
the sane, seem, on the insane, in many cases, to be wholly expended in
producing fluctuations on the animal spirits (not in bodily effects,) so
expended, as if this increase of the vital energies were neither subject
to the usual laws of corporeal nor intellectual distribution. These
insane, consequently, are less subject to disease from these causes, as
if they, no longer responsible, paid not, therefore, the price of the use
and abuse of the energies continually imparted to all. It is true, that
the life they lead, not only removes them from many causes of disease,
but the very nature of their diseased state, also, renders the mind more
susceptible of impressions, for, beside their excited state, by being
shut out from the world, they necessarily give to trifles all the
importance of weightier matters, and thus it is, that by their being the
victims of mental excitement, {133a} which is every where a protection
against prevailing diseases, they are not so liable to be attacked by the
prevailing epidemics. {133b}
Whatever influences prevail externally, they must in all cases, sane and
insane, be counteracted and modified by internal influences.
But to enter upon this investigation is not at present my intention,
therefore I shall not now examine the question, whether the epidemics of
different times, and the character of all diseases, which always partake,
more or less, of the prevailing epidemic, can be _wholly_ {134} explained
as being caused by some difference in the prevailing state of the
weather. I shall only remark that it is certain such seasons and states
of the weather are equally fruitful in the production of insanity and in
the excitement of those already insane. Yet, from these internal mental
or moral influences, it is evident that neither insanity nor epidemic
diseases can prevail exactly in proportion to the state of the weather,
unless it could be proved there always existed a correspondence between
the state of the weather and the moral and physical susceptibilities or
predisposition of the persons exposed to its influence.
At the same time I assert that our moral state has more to do with
disease, either directly or indirectly, than is generally credited, yet
these moral causes are necessarily every where physical in their
operation, so that the assertion that our physical corresponds with our
moral state, and what we call physical causes are the effects of this
state, need not alarm us, in fact, the interesting truth is now
demonstrated, {135} that health and longevity correspond with our moral
state, (though this is true as a general principle, there are many real
and apparent exceptions,) in fact, natural and moral effects co-operate,
just as the circulation depends on the nervous energy, so the nervous
energy depends greatly on our mental condition.
Whether, however, the causes of diseases are more of a mental or
corporeal character, is not now the question to decide.
For though in the Essay I propose to give on atmospheric influence, I
shall endeavour to point out the various causes which may give rise to an
irregular display of the spirits of the insane, I am far, however, from
denying, that there are alternate states of excitement and depression, of
better and worse days, which we may not be able to trace to these causes,
but which may depend on principles similar to other physical
intermittents, just as we have periodical head-aches, having their
accession and intermission most frequently every alternate day, and yet,
even in these cases, I have been able to discover the origin of these
head-aches, as was my own case, to alternate sleepless and distressing
nights. Looking at these periodical exacerbations of insanity, without
tracing them up to their first causes, they seem like the operation of
some disturbing cause, requiring a given time to arrive at their crisis,
or to produce the effect, and when produced, to subside again, and this
cause, thus viewed in its less remote operation, seems altogether of a
physical nature. But this periodicity, which I also advocate, will be
more fully examined in the third section of the Essay on Atmospheric
Influence, in which some observations will be ventured on lunar
influence.
Let the reader in the mean time take it for granted that such an
influence exists; we shall then be able to examine the modifying
influence which the peculiar state of the mind, in each, among the
insane, must have over their manner of exhibiting these alterations in
their animal spirits, especially among the old incurable cases,
labouring, as it has been said, under the chronic form of insanity.
Often, after the first attack, their minds are left in an imperfect
state; yet, notwithstanding this inability to discharge the functions of
mind properly, they generally retain their physical energies, enjoy
vigorous health, and, of course, the flow of their animal spirits
dependent thereon, is more likely to be improved than otherwise; with
respect to mind, however, they not merely want volition, and the common
motives and principles of control over themselves, but there have been
circumstances connected with their confinement, which, co-operating with
the excitement, (the cause of which I shall hereafter attempt to
explain,) have formed in the system regular periodical returns of these
states; so that, at these periods, they not only, more obviously, exhibit
these changes in their spirits, and, of course, display without disguise,
their peculiarities of mind, as children do, and sometimes as even men
do, when warmed with friendship, or with wine; but they also do so in a
higher degree, and, of course, with all their latent imperfections of
mind, in a much more striking manner; they then “show themselves,” their
peculiar character and defects; nor should this explanation of the
periodical return of these states of excitement, from the above-mentioned
co-operating causes, surprise us; we may every day witness the operation
of the same principle, among men possessed of reason.
We all know, whoever gratifies any passion, or accustoms the system to
any artificial stimulus, at stated periods, invariably finds the
difficulty of resisting this passion, and his inclination for this
stimulus greatest, at the usual period of gratification: and so it is
with the expenditure of animation; in fact, nothing is more certain, than
that both mind and body become the slave of those customs, which the
manner of our living, and moral conduct, and the circumstances through
which we have passed, have fastened around us. Now, as the circumstances
and treatment of the insane, have hitherto been different from common
life, (the object ought to be, in the treatment of the insane, to
resemble common life as much as possible;) and as they are without
control over themselves, their mode of displaying their more animated
state, must be as different from the civilized man, as the civilized man
is from the savage. If, then, habits of civilization may be called a
second nature, here it may be said, that a third has been superinduced.
From these circumstances and states of mind, it appears, that, instead of
their stock of animal spirits being expended, under the guidance of a
moral agency, and regularly diffused over their existence, they are
subject to mere physical influence, and become the sport of every eddying
wind that blows; and therefore we find every possible variety and
irregularity exhibited.—A perfect contrast to that of the good and wise
man, if such a one can be found, whose balance of mind is preserved,
whose spirits are tranquil and even, who enjoys perpetual sunshine
within, and diffuses peace and serenity around him.
Thus, because when their spirits are buoyant, they strangely exhibit
their inherent defects of mind, it has in many instances been mistaken
for an exacerbation or a returning accession of the disease, and called
the chronic type of old incurable cases.
It further appears, that this view is correct, from the fact, that if
their manner of talking and acting, in expending their increased flow of
spirits, is improperly encouraged or exasperated, then we find their
individual and latent defects become more obvious; but with proper
treatment, they gradually die away: in fact, these appearances are more
or less perceptible, in a great measure, according to the spirit and
conduct of the superintendant; and even, under him, to that of their
respective attendants. Of this, I could give some striking
illustrations. It is astonishing how much the increased flow of the
spirits will be dark, gloomy, and vindictive; or light, cheerful, and
full of kindliness; just as we by our treatment excite and keep alive one
part of the mind or another. The same principle might be illustrated
also, on a larger scale, by surveying the conduct of different parties
and governments in the world; and on a smaller scale we see every one in
authority, a magistrate, a gentleman, a minister, a pastor, the captain
of a ship, and a parent, stamp their character on the sphere in which
they move.
Were it the place, nothing could be more instructive than examples to
demonstrate the correctness of these observations.
The preceding case, I consider, is one of these examples. I have said,
that for the most part, these states of excitement and depression, are
merely an irregular exhibition in the accumulation and expenditure of the
animal spirits, and not always to be considered, according to Dr.
Halloran’s view, as the remains of the disease in the state of a
returning paroxysm, and that which characterises the permanently insane;
but that this originated in, and depended on, causes which equally affect
the animal spirits of the sane and insane, with this difference, that in
the insane, as in this case, they are modified by the peculiar state of
mind, and the sort of treatment they have received.
Grant that, from the state of his mind, any little increase of animation
would resemble, in a slight degree, that which he now exhibits, then I
am, by the help of facts, in this and some other cases of a similar
nature, justified in saying, that I have been able to trace the process
and progress of these changes, from small beginnings to their present
state. I know, from the best information, that his manner and appearance
were, when excited, so laughable and striking, that the attendants and
their friends, from want of proper feeling, or perhaps mere
thoughtlessness, actually made him a source of private sport and
amusement, and thus increased his excited state, which, in the course of
time, assumed its present peculiar and amusing form. {141}
A minute detail of all these things, together with unnecessary and
injudicious confinement, I am certain, would prove all this.
In many cases, and especially in the last, I have been able to trace, as
I have already said, the process and progress of these changes, from
small beginnings to their present state. In some cases, any little
increase of animation gave rise to manners and conversation, which were
extremely amusing, and such as tempted silly and unthinking people, as
well as the other patients, to encourage by listening or assenting too
much to them, or to exasperate by wantonly making them a source of sport
and amusement; conduct which cannot be too strongly deprecated,
especially during the critical period of their convalescence.
In most instances, however, it must be allowed, that among these old
incurable cases, {142} the most powerful exciting causes are within them.
When their minds are at all irradiated, striking ideas, and scenes of the
past, cross their imaginations; they are further excited by them; and in
proportion as the system is excited, these ideas are themselves more
powerfully awakened; they have no clear consciousness nor control over
themselves; and this dreaming state of their minds, to them all reality,
is sometimes as cheering as the dreams of hope can make it, and at other
times as horrible as the night-mare! and thus they are wrought up into
the most excited or exasperated state. In some cases, especially the
foregoing, this goes on until they are worn out, when they require a
corresponding portion of time to renew their vital energies; and thus
cause and effect mutually produce each other. These alternate states of
excitement and depression, being often repeated, they gradually increase
in strength and duration; and thus it is in some few cases, and
especially those similar to the last, we find, that their spirits are not
expended and renewed, as ours are, once in twenty-four hours, because
these changes have become the habitudes of their nature, so that their
system becomes governed by new laws of action. It is very singular that
those most liable to extremes, are most predisposed to insanity, and in
its more confirmed stage to this periodicity of excitement and
depression.
I have already noticed, {143} that the excitement of the depressing and
exhilarating passions alternately, is the most striking characteristic of
the old insane,—so striking that the general division of insanity is
intomania and melancholia; a division, however, which is altogether
unphilosophical, as the mania and melancholia are not any abstract
difference in the cause of the disease itself, but merely the results of
the over-active nervous energy operating in different directions—at one
time on the depressing, another on the exhilarating passions; this indeed
is the case, more or less, with all those who preserve not this mental
equilibrium, but who act more from the impulse of their feelings and
passions than the cold calculations of reason, and the rigid restraints
of principle. To what extremes are the passions of the human mind
liable, when neither the true light of the understanding nor any right
sense of justice guide them! We see this in ignorant and unprincipled
individuals, who suddenly rush out of their thraldom and pupilage into
liberty and licensciousness; we see the same thing exhibited by agitated
and wicked masses, as in the French Revolution, when the moral, like the
physical ocean, is let loose from its order and control, and heaves its
tumultuous waves of passion, as if by an earthquake, from one
overwhelming extreme to another.
When then, as in the insane, all the restraining powers of the mind are
lost, can we wonder that the mental energies should be subject to
accidental and baneful influences? that they should impetuously rush with
fearful, because with unguided force, into the most opposite and direful
extremes? These extremes, however, always correspond to the individual
peculiarity of mind, and the nature of the exciting causes, which
exciting causes often exist internally long before they become externally
evident; thus gradually forming ruts in those weak or soft parts of the
mind, as it were, in which their feelings are naturally more apt to run;
and thus they acquire the increasing facility and strength of habit, in
operating in one direction rather than another, until they become
irresistible: or in other words, until the understanding has no longer
the power to extricate the mind from their influence.—Body and mind have
been allowed conjointly and reciprocally to produce and increase these
effects. The effects are first, disordered action; next, inflamed and
diseased organization of the brain, as well as this disordered action
being continually strengthened by a daily increase in the power of mental
association, “calling forth an increased susceptibility to the action of
certain exciting causes;” and so far I agree with Dr. Halloran, that a
something like the original “accession of the disease,” more readily
takes place. {145a}
I have said, {145b} that in cases of permanent insanity, the alternations
into these opposite mental states occur most frequently among persons
whose previous character was marked by extremes,—who were easily excited,
and as easily depressed, either by their hopes, their fears, their anger,
or their affections. And I have often had occasion to hear these remarks
on their admission; and further, that they could not bear stimulants,
especially ardent spirits; and that there was insanity decidedly
developed during their worst paroxysms of intoxication.
In fact, the history of their lives, at least of some of them, was that
of comedy and tragedy, perpetually prophesying and exhibiting a
threatening prelude of their present more awful state; more awful in
appearance, because it has now become bereft of its former lucid
interludes; which lucid interludes had, possibly for some time, been
externally maintained only by the mere power of external moral
influences, long after the internal control had ceased to preside over
the mental operations.
We call it insanity when external restraints are broken down and
disregarded; we cannot decide how long absurd and delusive feelings and
notions have monopolized all the operations of the little world within.
I shall have occasion hereafter to adduce the history of many cases which
will serve to illustrate the truth of these views. I may briefly
mention, that they occur most frequently in those families where such a
constant April atmosphere exists: and, as a further argument it may be
stated, that a greater proportion of victims to these causes occur among
the women than among the men; and in the male sex we find they are those
of a more feminine character, or those whose feelings naturally
predominate over their understandings.
Thus children who resemble their parents, through the spirit in which
they were conceived and brought forth, become still more like them by
example and education; and hence the very important fact, that the
greater number of those who lose the power over their own minds, are from
among those who have been unaccustomed at an early stage of their
existence to exercise a salutary control over their feelings and habits;
and of those especially such as naturally possess strong animal and
sentimental feelings. Hence it is said, “that of all the causes of
mental derangement termed moral causes, perhaps the greatest number may
be traced to the error of early education.” {147} Thus, as I have
already remarked, an only child, or the youngest, (who has often as much
exclusive attachment as an only child, because he is the son of old age,
or is young when the rest cease to be children; or may be the only one
left at home,) are numerous amongst the insane.
Again, in confirmation of the same argument, we may here remark, that the
greatest number of those who become insane, become so between the ages of
thirty and forty,—a period when establishments are formed, and habits
have been strengthened by time, while the feelings yet retain all their
energy and susceptibility of action. Thus we can conceive why reverses
and disappointments should then have the most fatal and overwhelming
influence.—Still less need we wonder that this should happen to those
whose animal propensities and sentimental feelings have been exclusively
cultivated, as they then find that if understanding and principle are
insufficient to restrain them, the claims of society forbid their
gratification. Hence the conflict becomes dreadful and dangerous,
confounding and overturning the balance of the mind. Even without this,
bad passions, disjointed and exclusive habits of feeling and thinking can
hardly go on progressively increasing to this age, without becoming so
irresistible as to threaten to destroy and swallow up in their vortex all
that remains of the man within them. Such is a true and beautiful
description that Johnson has given of Imlac’s insanity in his Rasselas.
Any passion or propensity of our souls, when improperly indulged and
carried to excess, is an abnegation of reason; and in saying this, we
give a true definition of insanity, however startling this wide
application may appear.
What is the most obvious history of most cases?—Thoughts and feelings are
indulged on any given point, to the detriment or suppression of others
which might draw us from this dangerous and exclusive habit of the mind;
till at last we become incapable of resisting any other train of thought,
and feeling, and action; “they are at first imperious, and at last
despotic.”
When and how are all these evils to be best prevented? We answer, in the
preliminary stage of our existence. We shall revert to this important
subject in an essay on the primary principles of education; and shall
only now remark, that where we perceive a soil full of the seeds of all
these evils, we can expect only corresponding fruits? We shall conclude
these remarks by directing the reader to look to the soil where these
evils exist: we do this, because it exhibits the truth of the principle
for which we are contending.
We see, in the history of families, that the extremes of heartless
tyranny on the one hand, and the foolish fondness of blind affection on
the other, engender soils equally favourable to the production of these
terrible fruits to which we allude: still more so is this the case where
these extremes exist in the same family.
Many are the married persons who waste their lives in inordinately and
alternately hating and loving each other. From small beginnings, breezes
arise and gather into storms; at last, exhausted by their violence, they
subside, and for a while love returns, and all its ardent affection.
Such is the brief but sad history of many a matrimonial union,—but who
can describe its baneful influence?—how much evil and misery are
propagated! how much reason and principle, health and happiness,
reputation and prosperity, are sacrificed in those families, whose
parents thus suffer reason and understanding to be the victims of these
opposite and alternate mental states!
Of which states, such as become insane, are but the caricature samples of
the hereditary family infirmities, and the actual habits of their lives;
and perhaps this may happen to one less a hypocrite than the rest,
because in such a one, the external and internal become more easily and
readily in fixed and permanent correspondence. It is natural, therefore,
to expect that this same character will be exhibited still more
conspicuously after the understanding has altogether ceased to perform
its godlike attribute of rightly using the light of pure reason so as to
enthrone and support that one grand ruling principle to which the whole
mind should be obedient and subordinate.
I have been the more particular in making these observations, because I
conceive they may be useful in a medical point of view. They may prevent
us from mistaking the simple, though modified, changes of the natural ebb
and flow of our animal spirits, for an exacerbation or new accession of
insanity,—and thus warn us from treating the patient with unnecessary
restraint, as though he were suffering from a new attack, and from
blindly endeavouring to cure a hopeless case by the wanton administration
of strong and deleterious drugs, which in most instances would destroy
health, as well as the remnant of the faculties: “In the diseases of the
mind, as well as in all other ailments, it is an art of no little
importance, to administer medicines properly; but it is an art of much
greater and more difficult acquisition, to know when to suspend, or
altogether omit them.” {151}
_No._ 8.—_Admitted_ 1783.
No statement on record. He was a respectable country Clergyman: his
friends say he was a hard student, neglecting exercise, and all attention
to himself or his health, and which had, for some time previous to the
attack of derangement, been in a very precarious state—the attack was
very sudden and violent.
He has a leprous eruption, which has continued since the time of his
admission until now, without any very perceptibly abatement. He was
formerly the most furious maniac amongst the old incurable cases, though
less strikingly peculiar in his appearance and manners than the one last
described. During the paroxysms of his greatest fury, he appeared like
one whose mind, from excruciating pain and dreadful mental provocation,
was wrought up to the highest pitch of passion and revenge; so that he
would, as though he had the object of his malignity before him, be
incessantly repeating, through whole nights and days, some single phrase,
such as, “damn’d dog,” with a sort of suppressed barking, roaring
furiousness, even until he foamed at the mouth, and his face was black
with passion.
He was most violent when the eruption appeared least on the external
surface. When his mind was more at ease, he would play like a little
child for whole days together, with the merest trifle, such as a piece of
string or paper. At these times, when given any thing he likes, he has
something singularly fascinating in his smile.
For this eruption, many things had been administered, without any
permanent advantage. Solution of nitric acid, about three years ago,
{152} appeared to have, for a time, a good effect; the eruption became
somewhat less, and the mind less violent: but this might arise from the
debilitating effects, rather than the radical removal of the cause of his
disease. After this, the solution of nitrate of potash, had a good
effect both on his mind and the disease of his skin, without reducing or
debilitating his system. He has lived, for this last twelve months, on
vegetable diet, and he is apparently better; but this may be a fallacious
appearance, since his vital energies appear to be sinking.
OBSERVATION VI.
It has been said, by the late Dr. Jenner, and some others, that cutaneous
disorders are common to the insane. I should think they are not very
common. {153} This is the only case that I have seen, where the two have
continued to exist together. Whether it was the original cause of his
mental malady, I have not been able to ascertain, but it is certain, it
aggravated it. That mania, in some instances, follows the disappearance
of eruptions, ulcers, and other local diseases, particularly with
females, is satisfactorily established; but in many instances, other
causes co-operate.
In cases of dementia, arising apparently from continued pressure on the
brain, the surface, from the general bad habit of the system, is liable
to sores, boils, and ulcerations. This cannot be called a cutaneous
disease; it is rather a symptom of the diseased state of the brain, than
itself the cause of insanity. Glandular swellings, however, seem to have
a more direct connection; but still they appear rather before, than after
the alienation has taken place. In a few cases, I have noticed slight
eruptions during recent paroxysms, and in two or three, immediately
previous to their convalescent state. Had such appearances occurred more
frequently, I should gladly have regarded them as favourable prognostics;
but they might arise from strong medicines, their state of confinement,
or they might be mere accidental coincidences. There are many instances
of cures by accidental injuries, {154a} as well as by the accession of
consumption and other physical diseases.
Here I leave the question for the present, till I come to some cases,
where, according to the theory of such a connection subsisting, (which I
believe is the case in a few instances,) the tartarized antimonial
ointment has been applied; {154b} but I confess, that there is no part of
my experience in which my sanguine expectations of cure, after a certain
duration of the disease, on this principle of counteraction, have been
more disappointed. In the early stages of insanity, it is decidedly the
most valuable principle in our practice.
_No._ 9.—_Admitted_ 1793.
No statement on record, that gives any satisfactory information. She was
a respectable farmer’s wife, and her insanity was occasioned by her
husband’s heavy losses of cattle. Her first symptom was throwing her
little infant at the feet of the parish officers, saying, “there, take
it.” {155} She often repeats, with a very moaning sound, and tears, “God
rest thy soul, poor old mare.” She will be easily known, when I say, she
is a poor, moaning, miserable looking imbecile, constantly sitting
cowering in a corner, always crying for tobacco. She was one of those
who were kept naked in loose straw, and hence her inclination to undress
herself, her dirty habits, and her peculiar mode of sitting: indeed,
formerly, throughout the house, the lowest and worst patients had no
seats allowed them.
_No._ 10.—_Admitted_ 1793.
Nothing recorded of this case. It is said, that when young, he was
severely kicked by a horse. There is now a considerable indentation just
above his left ear.
His mind, though extremely childish, is altogether in a torpid state, for
the most part quiet and good-natured; but sometimes, when more excited,
he exhibits a love of mischief, generally very childishly, but sometimes
more seriously so. {156a} His temperament is phlegmatic, and he has a
heavy, dull look. He has been for years employed in the garden.
_No._ 11.—_Admitted_ 1793.
Nothing on record. I have been informed, that he was a well-sinker, and
that his insanity was the consequence of a rheumatic fever. No one,
except a complete idiot, can be in a more stupidly stagnant state of
mind; he scarcely notices any thing, and never speaks unless spoken to,
and then his answers are merely monosyllables. About once in twelve
months, a slight exhibition of excitement shows itself in a sort of
ill-tempered obstinate fit, {156b} but which soon subsides, especially
with the aid of sulphate of magnesia. He is, together with No. 10,
constantly employed in the garden.
OBSERVATION VII.
The observation which suggests itself on No. 10 and 11, is, that from
such facts as these, it is very evident, there can scarcely be an old
pauper patient in such a state as wholly incapacitates him from being
brought, with a little trouble, into habits of useful employment.
As stupid men are generally less diverted from an object which once
engages their attention, than men of greater capacity; so it is with
these poor automata; if the first difficulty be but once overcome, that
of acquiring the habit of working, there is no fear; but they will
proceed in it more steadily than those who feel that they have a right to
consult their own choice. They cannot be tempted, nor do they possess
the power of giving their energies a new direction; and hence, as habit
gathers strength, we may depend on them as on our time-pieces. If
amusements and employment are good for these, how much better for those
who are not past the hope of recovery; it may change the object of their
thoughts, and gradually turn them to one of a less dangerous nature. I
shall have some very interesting cures, partly attributable to this
principle, to state in due course; in the mean time we perceive, that if
even they are past the hope of recovery, they are kept in a better and
more healthful state; and what is more, it diffuses a satisfactory
feeling through the whole system, and they are made happier than they
would be by a life of idleness.
_No._ 12.—_Admitted_ 1797.
Nothing on record; and I have failed in my efforts to obtain any
information of her previous history. It is said, that her relations are
respectable; yet her residence here is paid for by a parish in London.
She has long been, together with No. 7, the most useful and hardworking
person in the house. In the midst of her work, she will often scold and
swear with vehemence, but no one knows about what, or against whom; and
though her voice is loud and shrill, no one regards it, saying, “Oh! it
is only poor M. W.” Yet she is very kind-hearted and friendly, giving
away her own meat, especially to those who are ill; and when prevented
from doing so, will throw it away with indignation. She would gladly
starve herself to feed others; and always asserts, when a patient dies,
“that they died for want of something to eat.” She used to practice this
singular fancy, that of frightening the devil away, by taking a sweeping
brush with her to bed; but now, a tin pint serves the same purpose. She
is a tall, meagre-looking woman.
_No._ 13.—_Admitted_ 1798.
No statement of this case; but it is said that, in the first instance, he
was very violent. His mind is now in a fixed imbecile state, and
exhibits no alteration, except the slight changes which mere alterations
of our spirits produce; when he is more easily provoked—talks, laughs,
and sings more, or holds conversations with persons dead or absent;
sometimes scolds them, fancying they tease him in some strange manner,
which he calls “triangling;” but it is impossible to ascertain what ideas
he affixes to the word; he is a very quiet, good-natured man, a general
favourite, and is usefully employed by the attendants in the house. {159}
_No._ 14.—_Admitted_ 1799.
No statement of her case; and I have failed in obtaining any very
satisfactory information about her.
[Picture: No. 14 page 159]
It is said, that she gradually became insane, after the death of her only
boy, named “Charles,” (who was the natural son of Sir —:) this is
probably true, as she now imagines that Charles is constantly with
her—sleeps with her—that she feeds him at her meals—carries him about in
a corner of her apron—nurses him—and talks to him with delight and
maternal fondness. She often fancies, too, that she has been confined,
and has got more children. {160}
Her appearance and manners are exceedingly polite, pleasing, and
affectionate; she is attentive to others, in all those little nameless
etiquettes of life, which, when regulated by truth, constitute the
innocent fascination of a kind-hearted and well-bred character; and it is
so with her: every one doats upon her as upon a favourite child. She
never fails to tell me, if I have been out during dinner-time, when she
next meets me, “you have not got your dinner, go and get it immediately;”
and yet left to herself, she is wholly taken up with scolding some
imaginary beings who annoy her, get into her throat, head, back, &c., run
her through with swords, and do a thousand other strange and cruel things
to her. Every evening she has a long scolding, with a tone three-fourths
of anger and one-fourth affection, with some men who plague her in her
bed and in her bed-room, and continue to do so till her attendant comes,
sometimes at her call, to drive them away. Is this the lingering last
impression made on her mind by her seducer? In the midst of her scolding
she will often swear in a strange under tone of voice; and when accused,
she says it is some other person, frequently Jack Swales. Her
conversation is so exceedingly extravagant and varied, that it is
impossible, except by the most lengthened description, to convey to
others any adequate conception of it. Names of dukes, kings, queens,
pipes of wine, sums of money, estates, &c., are as common to her as
household words; yet strange as all this is, it seems to have some
connexion with her past life, having formerly held a situation in a
family of consequence. Her former situation and disposition are hinted
at by these reminiscences, which are delightful traits of what she has
been.
_No._ 15.—_Admitted_ 1799.—_Aged_ 50.
No statement on record; it is certain, however, from his own account,
that he was formerly steward and butler in a gentleman’s family, and had
been what some call a “hearty good fellow” all his life. His manner
continued that of a blustering, passionate, half-inebriated man; {162}
his skin was covered with a scorbutic eruption, and his face a bloated
livid red. He died of dropsy in the chest, March 6th, 1821.
OBSERVATION VIII.
The observation, or rather the moral, in this case is so obvious, that it
is almost superfluous to add, that from the nature of his case, and his
own account of himself, his system both of body and mind had been brought
into the extreme state of morbid irritability by the conjoined excitement
of the dissipated companions, particularly of his early life,—unchecked
in their effects by the exercise of any moral restraint over himself; and
hence his mental powers and passions were not so much shattered and
decayed, as they were like a vessel without its pilot, the sport of every
wind and wave that assails it: bad habits had become too inveterate to
allow the will to be taught obedience to reason; all measures of
coercion, instead of inducing self-control, could only irritate and
exasperate, as he was perhaps still less accessible by religion than by
reason. I believe, however, that by gentle, and indirect means, he
gradually became less boisterous in his manners; but it is proper also to
add, that from age and disease, the sinking of his physical powers and
animal spirits might imperceptibly, but more effectually, tame him.
_No._ 16.—_Admitted_ 1799.
Nothing on record.—It is said she was a belle: she is thin and tall, and
is remarkable for a demure, prim, affected, stiff manner of sitting, like
vanity turned to stone. She will spend hours in dressing, undressing,
washing, &c. I have never heard her say more than “pretty well, thank
you.” Her mind seems rather empty and motionless than diseased or
deranged.
[Picture: No. 16 page 163]
_No._ 17.—_Admitted_ 1799.
Nothing on record.—She is a neat, clean, but rather crabbed-looking,
middle-aged woman; and who, unless she is provoked, is scarcely to be
distinguished from the sane; but when provoked, she is exceedingly
abusive, and exhibits the deranged state of her mind. She is very useful
as a laundress, and is known only by that name. The great objects of her
affections are cats and kittens. {164}
_No._ 18.—_Admitted_ 1800.
Nothing on record.—He was an Italian, of a swarthy complexion, dark eyes,
black hair; and to look on his countenance reminded one of an assassin,
“the mark was upon him.” He was subject to violent fits of excitement
when he was suspicious and thought himself insulted by a look or a word;
and from his ignorance of the English language, he might perhaps have
greater scope for suspicion. When offended, he gnashed his teeth;
striking one hand violently against the other; appearing from these, and
various other indications, to be preparing for action, and lashing
himself into a state of the most determined revenge, he watched his
opportunity, and seizing his victim with his teeth, was quite delighted
if he drew blood. He bit several, some seriously; and in one instance,
he bit a piece completely out of the lip of another. They all agree in
the house that they never saw a patient so ferocious, or one where harsh
measures _seemed_ more justifiable; yet nothing could conquer him—his
attendant believes “he would have died first.” It was no accidental
result of passion, but the settled object of his mind. {165a} He would
chuckle and triumph over the injury he had done; and this was the more
remarkable, as his mind in other respects was so much gone, that he
continued to the time of his leaving the asylum, occasionally a dirty
patient. Still it ought to be stated, that this ferocious disposition
and these dirty habits, if they had not been absolutely grafted on his
natural disposition, must have at any rate been made much worse by his
brutalizing treatment; for he was one of those who were formerly kept
naked in loose straw,—besides having during this time lost his toes,
supposed to be from his exposure to the cold, he could not so well defend
himself, and so might have been taught by necessity to have recourse to
his teeth. That he was made worse by his treatment, is evident, as
latterly he became sensible of kindness, and improved in personal
cleanliness; and his general manners indicated much less malignity of
feeling; indeed something like affection {165b} and gratitude to his
attendants, began to excite in them, without effort, kindly feelings
towards him. At first, (after the new state of things) it was with the
utmost difficulty that he was made to keep his clothes on, or to be kept
clean; but latterly, for many weeks together, he went on without any
restraint whatever. He was removed in May, 1822.
OBSERVATION IX.
The observations that naturally suggest themselves on this case on the
efficiency of mild treatment, are so obvious, that it would be obtrusive
particularly to state them. I cannot, however, omit adverting to the
fact of the probability of his having lost his toes by exposure to cold,
because it illustrates the remark made in observation V. Patients, in
former times, were kept naked in loose straw; and from their exposure to
cold, mortifications in the extreme parts were common; and then writers
on insanity say, that mortification of the extreme parts and
insensibility to cold, are symptoms of mental derangement!!—See also
observation 12th.
_No._ 19.—_Admitted_ 1800.
Nothing on record. He was a respectable tradesman.
He is constantly muttering and talking to himself, apparently busy in
making calculations, holding in his hand something he calls an almanack,
made by himself, as well as some pieces of money he has polished. He
repeats something, seemingly as a duty imposed upon him, perhaps meant as
a prayer. Though the shrivelled and decayed scraps of mind that remain,
look only like the apparitions of his previous habits of life; yet they
so wholly engross his attention, that he never notices passing and
external objects around him. Sometimes, however, he can with great
difficulty be for a moment diverted from his object, and while roused,
will answer questions with considerable point and shrewdness, but returns
as quickly into the same uniform abstracted state.
He is evidently of a contented and happy disposition. There is something
in his appearance and countenance which seems to say, “I have been a
respectable and good-natured fellow.”
OBSERVATION X.
The only observation here is one which I shall notice more particularly
when I come to treat on the efficacy of moral management—viz. that,
notwithstanding the deranged state of his mind, and the imaginary objects
which occupy his attention, still he can be roused for a moment to
something like a proper use of his faculties.
_No._ 20.—_Admitted_ 1801.
Nothing satisfactory on record. Said to have been a violent maniac. He
was kept naked on loose straw. Since that time it is said he was
improved by a seton; but still he was to the last a stupid, heavy,
idiotical looking man, and in reality was so. {168} That he was less
dirty, and kept himself dressed, was owing to better habits, into which
proper management had gradually moulded him. But his mind was
irrecoverably gone; he was motionless and silent, unless spoken to, or
urged to some action. His replies were merely monosyllabic, and these
only correct when they referred to something he had formerly best known;
he was, however, drilled into some degree of usefulness, in helping about
the wash-house. He was removed by his friends in April, 1821.
[Picture: No. 20 page 168]
_No._ 21.—_Admitted_ 1801.
Nothing on record.—He was one of those who was formerly kept naked on
loose straw. He has been for years, for the most part, in a moping,
poring, and solitary looking state; yet he has had occasional seasons of
excitement, when the disposition towards furious revenge seemed to
possess him, so much so, that he would, unprovoked, place his back
against a corner of the wall in the attitude of self-defence, shaking his
doubled fists in a daring and threatening manner. Though these
effervescences of his spirits occur as frequently as ever, yet the
malicious disposition seems dying away, and instead of which he will, at
these periods, sing a little comic air, and give other indications of his
mind being happy and full of good-nature, as much so as the little mind
he possesses will enable him to be, if, indeed, beings in such a state
can be said to have minds at all; for what an appalling difference
between them and minds enriched with laborious habits of reading and
reflection!
OBSERVATION XI.
In addition to the observations already made on former and present
treatment, it is only justice further to say, that amongst recent
patients, I have scarcely seen (if indeed I have seen) one instance of
continued revenge. Their spirits exhibit themselves in good or
ill-nature, according to the direction that is given them, and even in
the old cases, as in the one above stated, it appears simply the remains
of their former usage; so that if their minds are still agitated in some
sort with feelings of revenge, it is only like the sea which will
fluctuate awhile after the storm has ceased; but the winds are hushed,
and every wave becomes less and less, until it subsides into a calm.
_No._ 22.—_Admitted_ 1801.
Nothing on record.—I have been informed, that his mind was instantly
wrecked by the female of his heart unexpectedly marrying another the very
day previous to that on which she had promised to be made his own for
ever. He was an idiot, who could barely answer in a low whisper, and to
a few very simple questions, “yes” or “no.” He was old, and pale, and
thin—had a long face—his head hanging forwards—his stare was ludicrously
vacant and goggling—his lower jaw fallen, and saliva flowing over his
large hanging lip—though he generally stood quietly in a corner with his
face to the wall, yet sometimes he would for some hours together make a
strange and disagreeable noise—what was still more disgusting about him,
he had the sickening habit of bringing up his food and regorging it, yet,
in other respects he was not a dirty patient—perhaps because having been
with a better class, he had received more attention.—He had this singular
fancy, that if he had one or fifty pieces of bread and butter, he would
eat, or secrete, or pocket them all, except one. He gradually declined
from old age, and died in December, 1821.
_No._ 23.—_Admitted_ 1801.
No statement of his case. It is reported that he was a clever man, a
hard student, fond of political subjects, and that speculations on the
national debt were the cause of his insanity.—This report receives a
colouring of probability from two large trunks full of books now in the
Asylum belonging to him, almost wholly on subjects of political science,
among which is a large collection of pamphlets on the national debt, and
it is apparently confirmed by the nature of his hallucination; only I
cannot trace the report to any certain source. It is certain he was
Superintendant of the Police at Bombay.
His appearance and manners are very peculiar, and very difficult to
describe. He holds his head forwards and obliquely upwards in a
calculating position; moving his hands in different directions, and
working with his fingers like unto one gathering something in the air.—At
times he extends and stretches his hands higher than his head, moving and
working them in the same manner: he will hold his face directly
upwards—open and shut his mouth in a gaping and catching style, as if he
were feeding on air; repeating these operations, and intermingling them
with a strange gurgling noise in his throat—almost always muttering to
himself as if he held busy converse with his own thoughts, with visible
appearances of pleasure or anger on his countenance, occasioned by his
imaginary operations being successful or otherwise.
Though he is sometimes as immoveable as a statue, yet he is for the most
part moving about, and has a singular mode of treading with his feet like
one who has been accustomed to a tread-mill, lifting them higher than
necessary, and setting them down cautiously,—sometimes pulling off his
shoes—sometimes, however, quickening all his motions, as if something
required extraordinary haste and dispatch; and thus he marches about like
some star-gazer treading on precious and frail materials; seldom more
than a few moments in one place, and in all his movements in different
rooms and parts and corners of his gallery, stairs, and airing court, and
in all his operations and mutterings it is evident that he, in his
imagination, is performing some essential part of his _mighty task of
paying the national debt_, for when any of his operations or mutterings
are interrupted, like one whose studies are suddenly broken in upon at
some unlucky moment, he seems vexed and unhinged; sometimes bursting into
a violent passion, when he is most eloquent in the use of scurrilous
epithets (a proof that to use abusive epithets requires very little mind)
calling the person who has impeded him in his great work, low-bred, mean,
dirty scoundrel, rascal, villain, thief, vagabond, madman; accusing him
of being the cause of the loss of many millions to the nation,
threatening him with the direst punishment, particularly that he shall be
whipped in the air. He is otherwise remarkably quiet and inoffensive,
and uniformly intent upon this object, except that sometimes, as already
stated, he appears unhinged and irritable by the unsuccessful issue of
his calculations, and is then more liable to take offence, especially at
any disrespectful deportment towards him, for it must be observed that he
is still very fond of his title and of that deference due to a man of
rank. Occasionally, like some alchemist of old, he fancies that some
äerial being, which he calls the clown of the air, plagues him in various
strange ways and interrupts his operations, for which mischievous
interference he, in his way, severely scolds him.
The politeness which may be traced in his manners, is evidently the
result or remains of his old habits, as he is so absorbed in abstract
speculations that all attention to himself or external objects is utterly
excluded; he is always solitary, but it is like the solitariness of one
whose intense studies allow him no time for fellowship or the exercise of
social feelings, so much so, that notwithstanding a consciousness of kind
and respectful treatment towards him, he scarcely yet seems to know the
name of his attendant.
Although his system is delicately susceptible of changes of temperature,
he scarcely ever notices it himself; and when roused to pay attention to
his feelings, he says that it is the clown in the air that has teased him
with the iron ague.
He has been subject to occasional attacks of asthma, brought on,
apparently, by exposure to cold in the night time, during these
operations, (for he frequently jumps out of his bed to carry on this
great patriotic duty.)
Though he can, if properly roused and managed, still answer questions
much more correctly than all these appearances would indicate, yet it is
evident that his mind is gradually declining, from age, exertion, and the
nature of his case; he is an object of interest and sympathy, and nothing
can exceed the way in which it is shewn towards him by his attendant.
OBSERVATION XII.
The correspondence between the insane state and the previous character
and habits are in most cases, and certainly in this, very striking. On
this subject I refer to the Essay on the Changes and Correspondence
between the previous Natural Character, and that which they exhibit in
their Insane State.
There is another fact in this last case, which may conveniently serve the
purpose of introducing some observations ON THE EFFECTS OF HEAT AND COLD
AND THE STATE AND CHANGES OF TEMPERATURE IN INSANE PERSONS, which may be
considered as an Appendage to the remarks made in Observation V. and IX.
The fact to which I allude in this case is this, viz. that his system “is
delicately susceptible of changes of temperature, but that he himself
scarcely ever notices it.”
When the hallucinations of the insane are purely intellectual, and wholly
and intensely occupy the attention, the generation of animal heat appears
less than usual; and decidedly less than in those cases where the
aberrations of the mind are connected with the stimulus of selfish and
exciting passions,—hence the system is cold. But this arises rather from
defective quantity of heat, than from any irregularity in its
distribution; and thus, while the mind, from its state of abstraction,
either disregards, or is wholly unconscious of exposure to the cold, the
body is very sensibly and strongly affected by it.
In the last stages of gradual decay of mind, the changes and disturbances
in the quantity, state, and diffusion of heat, resemble that observable
in paralytics; there is great insensibility to heat and cold, and the
infliction of pain; and, previous to the period of their dissolution, the
slightest pressure, even so slight as to give no pain, produces
ulcerations, which rapidly degenerate into gangrenous ulcers.—In old
torpid cases of neglect—cases of suspension of mind; and in cases of pure
mental abstraction, it is deficient in quantity, although equable in its
diffusion.
In all these cases, as well as in cases of over activity of mind,
especially during violent paroxysms, there is a general loss, or want, of
consciousness to the usual impression of the corporeal system.
Sometimes, however, this consciousness is on some points morbidly acute,
indicated by strange sounds, and sights, desires, or aversions, &c.,
according to the parts or organs affected. In fact, it is this undue
concentration of energy, which abstracts or confuses, rather than
destroys the proper diffusion of consciousness.
Hence the insane, during violent paroxysms, bear the want of sleep and
food, resist the action of severe cold, and the effects of large doses of
strong medicines. In most cases their minds are so absorbed or suspended
during their paroxysms that passing and external events are wholly
excluded, and though some few, after their recovery, vividly remember
their dreadful dreams; to others, all has been a blank, and they feel
just as a person feels respecting that section of the country in which he
happens to sleep as he travels; but all these things, (which I intend
shall be noticed more particularly hereafter,) are not peculiar to the
insane, as has been held by some; they are equally the case with patients
during the paroxysms and delirium in the inflammatory stage of fevers.
Indeed, the same principle is exemplified in the cases of men of spirit
or energy, who, during the excitement produced by the achievement of some
difficult enterprise, bear the want of food and sleep, and resist the
effects of cold and exhaustion, to an extent which would seem to have
exempted them from the common laws of humanity, and these are the
incidents in life which are never forgotten; but then, as with the
insane, this extraordinary expenditure of the cerebral energy leaves the
system exhausted, and it requires all our art and care to recover the
enfeebled powers. It is this critical period of convalescence which is
so important, and so difficult in the management of the insane.
I further observe, that the variation of temperature of the system,
observed during paroxysms of insanity, is more like that produced by the
passions in a state of excitement than that which accompanies
inflammatory fever. It appears to fluctuate in quantity, and to be
tumultuous in its distribution, in proportion as the exciting and
depressing passions are active and contending with each other. In proof
of the truth of this, I need only mention that every thing which excites
the malignant passions, or produces misery and distraction of mind,
increases these appearances. I allude not merely to the expression of
the countenance, but to the absolute heat of different parts of the
system,—of different parts of the head in particular, of which they
complain and to which they point distinctly, being often sensible to the
external touch of another. It is to be remarked, that the changes and
unequal diffusion of heat in other parts of the body correspond with the
general and particular state of the mind: indeed the condition, (as it
regards health or disease) of each part of the bodily system, directly or
indirectly, corresponds with, and indicates states of the mind: but this
truth requires more than an observation to do it justice; I make the
remark, however, in the mean time, because there is no better guide to us
in our treatment than this knowledge, and it explains this temperature as
one of the corresponding effects. And though I shall not now enter on
the medical nature of the treatment these indications afford us, neither
is it necessary to say what kind of moral treatment they point out to us
as our wisest course to pursue. In all such cases, and indeed in every
case, we ought always to be anxious not only to keep our sympathies
alive, but, in order that we may never fail rightly to direct them, we
must also possess ourselves of a thorough knowledge of the mind, and its
individual peculiarities.—To give settled calmness and tranquillity to
the distracted mind, and bloom to the wild and faded countenance, ought
not to be considered matters of trifling importance.
OBSERVATION XIII.
ON THE EFFECTS OF INTENSE STUDY, AND GENERAL INTEMPERANCE OF MIND.
Though the effect of intense study and general intemperance of mind, may
be better illustrated by many cases than by the preceding, yet for the
sake of the moral deducible from the combined view of this part of the
subject, and the preceding observations on the distribution of animal
heat, I am tempted briefly to glance at the important reflections
included within it; intending to resume a more elaborate consideration of
its merits when I come to the Essay on the Causes which produce Insanity.
In those cases where intense study has been considered as the exciting
cause of insanity, I have almost always been able, on closer
investigation, to trace it rather to the intemperate feelings and
sentiments of the mind, combined with the injudicious mode of procedure
and irregular habits attending it. In young students, these studies are
blamed; but, alas! how often have I ascertained that much greater and
more decided causes (_secret and wicked causes_) have long been
exercising the most baneful influence. In cases of regular and
well-balanced exertion, however severe, the effects were rather a general
depression and weakness of the whole nervous system than absolute
derangement, producing either debility or suspension of mind, but which
for its restoration required only cessation from accustomed exertions.
Calmness and tranquillity, combined with innocent diversions and general
attention to hygeian rules, invariably effected a cure.
I am the more particular on this point, as some authors on the subject of
insanity seem almost to discourage all mental exertion whatever; whereas,
we should never lose an opportunity of repeating the common observation,
that the judicious exercise of mind, as well as body, is equally
conducive to health and strength, as it is to mental improvement and
worth. Rightly to apportion and conjoin the exercise of the feelings and
understanding, as well as of the corporeal frame, constitutes the whole
of Physiology as applied to health. When the civil duties of life are
performed from right motives, we then are obedient to the first law of
nature, as well as of the Decalogue: then all is healthy co-operation—all
portions of the system have their fair proportion of exercise—none are
over-worked, neither in the individual nor in the mass—neither in body
nor in mind, as we at present see to be the case, singly and
collectively: everywhere the effect is similar, destructive alike of all
healthy, mental, and corporeal energy, and of all the sweet ties and
charities of life which bind families and societies together.
It is remarked by Dr. Arnold and Dr. Penel, that most mathematicians and
philosophers have not only lived to an advanced age, but have enjoyed
good health, and have been exempt from mental diseases. Perhaps the
number of such men vouchsafed to the world, has been too inconsiderable
to enable us to form any correct comparative estimate between them and
the rest of mankind, yet reason proclaims it true; and as far as medical
statistics furnish us with facts, they all tend to confirm the truth.
Certain it is, that nothing conduces so much to health and long life as
conduct, well regulated, and a mind habitually preserved in a state of
intellectual calmness.
Such exercise of the reflective faculties not merely subjugates, but
virtually diminishes the energy of the passions; for reflection convinces
that every improper gratification must produce dangerous consequences.
The very exertion of thought on subjects of exact enquiry, by
appropriating the vital energies to its more exalted purposes, abstracts
as much from the strength of the passions and propensities as it adds
might to the powers of reason and conscience to subdue and control them.
On the contrary, persons with vacant and ill-regulated minds, (instead of
possessing the passport to the wise and good, whose habits create in the
social circle cheerfulness and felicity, and from thence diffuse these
blessings to others around them,) fly, when unoccupied, to those who
expend the energies of their existence in senseless follies or sensual
gratifications. The virtuous man has an ever-living zeal about him,
which benevolence warmly inspires, and truth calmly regulates. There is
no destructive warfare among the powers of his mind, as is the case with
those whose zeal is _generated by pride_, _and nourished by malignity_,
but his more noble faculties take the lead in activity, and superintend
the whole; all are cheered and invigorated by the co-operation and
harmony that reigns among them. It is wonderful how with this proper
balance and use of the faculties they stimulate each other, and keep the
mind alive;—“Peace is within these walls, prosperity within these
palaces.” Such a one alone possesses his soul with the full use of its
instruments of operation. Where the powers of body mind are well
balanced—every thing is in its place—every part subservient to every
other—all reduced to practice—then the mental and corporeal powers wear
well—age brings few diseases, and no apprehensions—our peace of mind
becomes more settled—our wisdom greater—our friendships more valuable,
and we come to the grave in a full age, like a shock of corn in its
season. To say, that knowledge is power, is only to assert half the
truth: it is knowledge combined with moral worth, or as Solomon more
beautifully expresses it, “Wisdom is Strength.”—Without virtue, knowledge
is ruinous and destructive; with it, the progress of improvement and
happiness is illimitable,—here providence smiles—there she frowns; this
is equally applicable to individuals as well as nations. History is but
one large commentary on this truth, and when men (indeed such a period
appears now to dawn) have learned wisdom by the severe lessons of
providence, then the Rise and Progress, not “the Decline and Fall, of
Empires,” will be the title of the volumes of some future historian.
Were it not for the vast importance of the subject, this might seem the
place to introduce some observations on that most grievous error so
common among religious persons, of supposing that God requires, on sacred
matters, the abnegation of reason—of that reason which distinguishes men,
and without which there is no distinction between us and brutes;—it is
not merely our will, or affections, or instincts, but this will combined
with the superadded attribute of our own understanding which makes us
men, and makes us even images and likenesses, (so far as the will and
understanding are united, and exist in perfection,) of our Maker! These
doctors teach their hearers to dethrone reason, in order, as they say,
that the Gospel, the grace, the wisdom, the justice, and goodness of God,
may be exalted thereon. They call all this a reasonable and acceptable
service. Strange paradox! Wonderful perversion, that a view so
contradictory and false can be enforced with a fiery zeal that proves it
is believed, embraced, and retained under the influence of the fear, (and
not the conviction in the understanding,) that it is essential to their
salvation! yet I know this doctrine is the main branch, or the first
fruits of that grand fundamental error which is called in the strong
prophetic language of Scripture, “the abomination which maketh
desolate.”—Some of the effects are, separating faith from charity, truth
from goodness, _the will from the understanding_; and all that God hath,
according to the laws of order in the Creation ordained to be joined
together, it tears asunder, throwing the mind into a dislocated and
distracted state, destructive alike of its peace, and of the bonds which
preserve society together:—madness, wickedness, infidelity, and anarchy
are the fruits which it produces.
If people are destroyed for lack of knowledge—if to hate the light is a
proof of deeds being evil—if the fear of the Lord is the beginning of
wisdom—if this knowledge is the continent in the mind for the reception
of every other what shall we say of those who teach—that this—the first,
the best, the godlike gift of the Creator, must be sacrificed in order to
embrace the view of religion which they propose? I cannot use stronger
language than I have used already, but repeat that mental alienation is
one of the dreadful consequences of that doctrine which is emphatically
called the ‘abomination which maketh desolate;’—of that doctrine, whose
fruits are bitter, and which fills the mind with doubt, gloom, and
misery.
When the only true basis of religious knowledge is removed, and insane
notions occupy its place, what desolation follows!
At present, however, I will not enter into a clear and full explanation
of this momentous subject; but I trust hereafter I shall be able show,
that I am fully prepared to prove these assertions, and, moreover, to
prove that, besides the extremes of pride and presumption, despair and
misery, with endless indications that it is not according to the wisdom
which cometh from above, it is the most common and frightful cause of the
most incurable forms of insanity which I have found in lunatic asylums, I
repeat, however, that so important and awfully true are these facts in my
estimation, that I cannot remain contented with simply making these
slight allusions to them, and I therefore intend hereafter to attack the
error with all the force which my conception of its magnitude and baneful
influence can inspire. Oh! that I could attack it with such effect that
it would be rooted up for ever—so that it would no longer exist as the
cause, (as it has hitherto been,) of gloom, misery, and desolation to
minds of the most gentle, amiable, and acute construction. Such would
not be the case did mankind behold the delightful harmony which exists
between revealed truth and the constitution of the human mind. I see no
lines and separations in knowledge, but behold in each part a portion of
one grand whole. Science, intelligence, wisdom, and religion, are all
ONE, and woe to the man who separates them!
O that mankind knew these glorious truths, which are everywhere most
beautifully held forth to our view—not only knew these things, but knew
also the happiness of making all this knowledge increase the well being
and happiness of others around them! Then would the world possess the
channels for the right influx of the inspiration of the heart; and then
would that true and steady light be received into the understanding which
would prevent it from falling into the mazes and darkness of error, or
into actual evils and miseries of heart and of life.
Then, indeed, would the fire of Divine Love purify the earth of the human
mind;—then would the oil of charity be the fuel on the altar of every
heart;—then would the light of Divine Wisdom ascend into understanding,
there to remain a sun without clouds for ever.
_No._ 24.—_Admitted_ 1802.—_Aged_ 25.
Nothing on record. She was brought up tenderly and respectably: her
health was rendered delicate by close confinement at her needle-work, and
her fondness for reading and writing. She was from home when her mind
received a severe shock by the unexpected intelligence of her father
having put an end to his own existence. Soon after this a grievous
disappointment completed the overthrow of her mind. Before her father’s
death, it was generally supposed he was wealthy: she was then engaged to
one who had secured her affections; after her lover knew of her father’s
death, and the involved state of his affairs, he still continued to
profess his attachment, and held out the prospect of speedily fulfilling
his promise of marriage;—she believed him, until she happened
accidentally in company to cast her eye on the announcement of his
marriage to another, when she shuddered and shrieked, and exclaimed
“Wretch!” and from that moment she was insane, and has been so ever
since. Her lucid intervals are considerable; yet she always retains so
painful a recollection of this fact, that though fond of talking of all
other occurrences of her former life, she studiously evades all
conversation, or any question that at all alludes to this; so much so,
that from this fact, as well as some others, I think it highly probable
that even her present less violent, and less frequent paroxysms, are
partly brought on by associations which awaken the same agony of mind and
feelings of indignation as she then suffered. When highly excited, she
will, like one who has received some extreme provocation, (her face red
and swoln with rage) burst forth into the most violent passion, using the
most scurrilous language; sometimes it is maniacal fury; at other times,
only like one excessively angry, venting feelings by a hearty scolding;
at others, she is only perverse and sulky, and frequently merely odd and
flighty. All these symptoms for the most part occur, more or less, at
certain periods, (see Observation V. and Essay on Atmospherical
Influence,) but now they are something less violent at all times, and
sometimes, for many months in succession, so slight that strangers could
not perceive them, when she continues conversable and pleasant. She is
very agreeable and useful in the house, which she considers her home.
Perhaps this improvement may be attributed partly to the application of
the medical swing—partly to the greater mildness of her present
attendant: she is made happy by a little attention, and often visits her
friends in York. Her natural talents are good, and improved by reading;
her disposition is friendly and benevolent, but hasty, credulous, and
incautious.
_No._ 25.—_Admitted_ 1803.—_Aged_ 28.
Nothing satisfactory on record. I have been informed by his family and
friends, that he was a proud, passionate, spoiled child, and that the
immediate exciting causes of his derangement were these. Through the
interest of an elder brother, he expected to obtain a most lucrative and
respectable situation in the East Indies, but it was discovered on his
examination that he did not possess the requisite qualifications,
consequently, he was not merely disappointed, but his pride was doubly
mortified by being reduced to the necessity of undertaking the management
of a common farm; there, with several other causes, these things
operating on a spirit ill prepared for any adverse wind or the common
storms of life, soured his temper; and at last produced so exasperated
and violent a state of mind, that his mother, sisters, and friends, were
compelled on account of various outrageous acts of passion to confine
him.
[Picture: No. 25 page 190]
It is said that he was so violent after this, that it was deemed
necessary to punish him, by chaining him for years, at times, to another
patient; and yet, notwithstanding this treatment, it is evident from the
remark of an old journal he then wrote, that he possessed a considerable
proportion of mind; there are many excellent reflections on general
subjects, joined, it is true, with what must appear to others, trivial
observations, on the conduct of the attendants in the house. About two
years ago he was subject to maniacal fits of outrageous passion, when his
manner was proud and stalking, his voice loud and blustering, and his
language contemptuous and imperative; calling the house his own;
commanding every one of us as his servants, in grand style. The mention
of a single fact, out of an immense number, will be sufficient to
characterise his spirit and manners. Often have I seen him look at the
patients with ineffable arrogance and contempt, and say, in a style which
no acting could imitate, “Take this dog out of my sight.”
This violence and noise was so exciting to others, and unhappy for
himself, that after various attempts by methods of kindness and
argumentation, he was, without any previous threat, taken to the medical
swing, where I told him that I was sorry to be obliged to apply so severe
a medicine, but that I was certain from his conduct lately he must be
very unwell, and that this would cure him, and more to the same purpose.
Since this time, I have never heard any noise, or seen any violence about
him. The name of the swing, after this, was enough to check him; but now
even this was not necessary, and his seasons of excitement have from self
restraint disappeared; and he is now, though an old incurable case, much
more social than he was. In fact, he appears affable to me, and in some
measure, even is so to the patients around him. He is fond of whist, and
has very much improved in the game; and when I add to this, that reading
the newspapers, walking, taking large quantities of snuff, and laying
leaning on his arm, fill up his time, and that he is a dark, cadaverous,
sulky, proud, gaunt looking man, all the house will know him. {192}
_No._ 26.—_Admitted_ 1806—_Aged_ 45.
There was nothing on record; nor have I been able to obtain any
information about her previous history, except that she was a charwoman.
Her appearance was rather respectable, her manners and conversation were
distinguished by sort of bravado air of pride, very often extremely wild
and extravagant; she was particularly fond of boasting of and displaying
herself as being or doing something great and wonderful,—a general, lord
mayor, king, &c.—always a male, and had a full beard on the upper lip,
and her voice was more like that of a man than a woman. When addressed
as a female, she immediately said she was a man, or a woman turned into
one. She was very fond of decorating herself in a fantastic style. When
provoked, she swore and talked most brutishly and strangely. She was
removed May 15th, 1822—much in the same state, except that latterly she
was worse, and not so useful in the laundry as she had heretofore been.
_No._ 27.—_Admitted_ 1806.—_Aged_ 36.
Nothing on record about her, but report says, that others in the family
are insane; and that the exciting cause, in her case, was the loss of
some money she had saved in service as a cook.
She is at present in a state of imbecility of mind, and she looks a
quiet, timid, silent, motionless, stupid creature, sitting continually in
the same posture, like one _almost_ shivering with cold. Although
extremely peaceable and timid, yet her mind is irritable, wanting,
however, courage for retaliation, so that when provoked, she looks angry,
but walks away: she never speaks unless spoken to, and then her answers
are short, but mostly correct, though it is evidently all force work.
This has been for years her state, or rather debility, with scarcely any
perceptible changes, except that her mind appears gradually sinking. She
was formerly more conversable, and would have done something at her
needle, but at present she is always idle, and has latterly, from
inaction, become less cleanly in her person.
OBSERVATION XIV.
Her habits of saving (if the report be true) prove her love of money, the
loss of which would of course, be felt in proportion as she valued it;
and, with her exceedingly susceptible and delicate mind, it must have
been overpowering; hence, as in all hereditary cases, there was something
discoverable in the natural disposition which rendered the exciting cause
more efficient, and we find benevolence, caution, and consciousness
large, and self-esteem and combativeness defective.
_No._ 28.—_Admitted_ 1806.—_Aged_ 23.
There is nothing on record, but I have been informed that the cause was
religious controversy, resulting from association with the followers of
Johanna Southcote. {195} He was the son of a respectable country wright
and joiner, and had a decent ordinary education.
[Picture: No. 28 page 195]
His present state of mind presents a strange mass of confusion from which
nothing can be drawn or collected, except that from his fondness for
drawing houses, and different things connected with building, and from
his muttering to himself (for he declines all conversation with others)
something about measurement, the square being so much, &c. some traces of
his former habits of life, may be remarked and determined: the strange
and absurd material views of the coming new order of things, betray the
view which did (and I am told, still,) belong to that sectarian delusion.
He is chiefly distinguished by his unsocial habits, and by the singular
practice of always cramming a part of his meat, and sometimes other
things, into his ears, shoes, breeches, and different parts of his dress.
_No._ 29.—_Admitted_ 1808.—_Aged_ 47.
Once for all, I must say of these old cases, since there is no book or
documents concerning them, that the origin, nature, and progress of the
disease cannot now be known except from enquiries directly made, either
by writing, or of such friends as may occasionally visit them; and with
many of these lower class of patients, it cannot of course surprise us
that they should not have any friends to visit them after such a lapse of
time. This is more likely to be the fact when the character of the case
is of a more revolting nature—as is very singularly so of the one I am
about to describe. Yet she has had visitors, from whom, however, I was
not able to gather any information upon which I could depend; her
insanity was said to be hereditary, she having a sister who is insane.
She is one of those old cases which, in former times in this institution,
were kept naked in loose straw and not allowed seats; and hence she now,
from this deprivation, sits huddled up, resting on her calves, when worn
out by her violence, curled up like an urchin in a corner in a sort of
dog sleep, the slightest noise instantly rousing her, when she starts
into her strangely agitated state,—shaking her head and gnashing her
teeth, and uttering horrible curses with a sort of barking, hoarse, and
hideous gutteral sound, apparently against some object present to her
imagination; in this violence she formerly continued, sometimes for
weeks, latterly only for days, with the most part only for hours, with
scarcely any intermission. In fact, she was in appearance and manner the
most brutal and blasphemous demon—no imagination can picture any thing at
all equal to the awful reality; and yet it is a remarkable fact, that,
some years since, her intellect was restored by a very decided physical
cause, the breaking of her leg; when, during the process of the bone
uniting, her reason returned: her manners were mild, grateful, and
affable, and the tone of her voice was soft and sweet; and again, when
her leg was healed, she relapsed into the same violent state. It has
continued, excepting a short convalescence during an attack of dysentery:
and this is now more than seven years ago; and after which, an artificial
drain was kept open, but with no apparent benefit; the dysenteric attack
was also imitated, but with no further benefit or effect than its mere
physical depressing influence at the time. It is worthy of notice, that
when taken to the swing {198} a second time, she talked more sensibly,
refrained from swearing, promised to behave better, and in a sweet tone
begged not to be swung: since this time, she has been less violent, has
shaken her head and sworn less than before; indeed she has a more
good-natured manner, and very often expends her excitement in mirthful
dancing and singing, and generally seizes my hand, that I may dance with
her.
OBSERVATION XVIII.
Though the doctrine of Demons, or being possessed, has been discarded;
yet, in my opinion, it deserves a more serious consideration than medical
men imagine:—it involves the true theory of mind and matter, their
connection with each other, and the principles on which this connection
depends, and by which it is regulated. I shall leave this question for
the present, with the intention of returning to it at some future
opportunity. However, one thing this case serves to prove and
illustrate, which is, that whatever mysterious link the mind may
constitute in the order of being, it is certain that this is according to
or dependant on the physical condition of the material organs through
which this connection operates, so that the physical reasoning on
disordered and diseased organization remains precisely the same, whether
we admit or deny that the visible, and invisible world subsist together
and are in indissoluble connection.
_No._ 30.—_Admitted_ 1808.—_Aged_ 47.
I have not been able to obtain a very accurate or full history of this
old and incurable case. He was a clergyman of the Church of England. He
had been a hard reader and distinguished student at Cambridge, and he now
gives proof of his having been an excellent classic. It is said, that
after he had obtained a small vicarage, although not an immoral man, he
was gay and expensive in his habits. After the age of thirty, he hastily
married an exceedingly beautiful girl of about sixteen years of age, but
who was uneducated and from a low station of life. Afterwards
discovering her deficiencies as a companion, his love cooled into
indifference, and his naturally proud, impatient, and uncontrollable
temper was made worse; he treated her harshly, their quarrels became
habitual, and they lived in hatred, misery, and distraction together.
In this state of his disappointed affections he was seduced into various
intrigues. Shame, conscience, and loss of character, quarrels with his
parishioners, aggravated at the same time by a fall from his horse on his
head, increased his natural irratibility of temper, and so mortified his
pride, that he became desperate and attempted suicide. After this he had
a regular paroxysm of maniacal violence, which subsided, although it has
returned with considerable increasing intervals up to this time.
During his lucid intervals, he will talk of the harshness with which he
was used, when it was first considered necessary to remove him from home;
and there is no doubt there is some truth in his statements: at the same
time it seems right to observe that, if in any instance it can be
excusable to allow our natural feelings for a moment to overcome us, this
was one of such cases. The proud, malignant, and contemptuous manner
displayed in his violence, was irritating in the extreme.
About eight years ago, he continued for some time in a perfect state of
convalescence, and when the paroxysm returned, its violence and duration
appeared in proportion to the length of intermission. These paroxysms
and intervals of convalescence have since preserved the same ratio to
each other. It is remarkable that the last interval of convalescence,
commencing about five years ago, continued for more than three years,
which I attribute to the absence of causes of irritation, more delicate
and attentive treatment, and constant resources of various amusements.
During the whole of this time, he could not be persuaded to leave the
place; he said “It would not do;” that he “should soon be worse than
ever.” The name of home and his wife seemed to make him shudder; and
when asked if he should not like to go, he shook his head, turned away,
and said nothing; but he evidently painfully felt the association of old
exciting causes.
It ought, however, to be mentioned that during the whole of this time he
would frequently exhibit signs of great uneasiness and irritability,
would pace the gallery or airing court, in quick and hurried steps, and
afterwards call his attendants to play a game at whist or backgammon: at
these times he was in the habit of chewing orange-peel, which he
constantly carried in his pocket for that purpose, and afterwards he
would say his troubles were overcome. He has since had a return of his
insanity, from which he never perfectly recovered; I have since
understood that he is dead.
OBSERVATION XIX.
The most obvious remark suggested by this case is, that, like many old
cases, when once an irritable habit is established in any part of the
mind, how easily the mere association of old existing causes will
overturn the balance and introduce a relapse into the same state: no
exciting causes can have more power to do this, than the constant painful
state of mind which ill-assorted and unhappy marriages produce; and
therefore, the next most obvious remark suggested by this case, is the
evil which arises from the whole mind being ultimately disagreeably
affected by the contraction of hasty, mistaken, and ill-assorted
matrimonial connexions. As the sublime principle of rightly-constituted
and spiritual or mental marriage is involved in the consideration of such
cases; and as, from the want of a proper understanding of this principle
being duly impressed upon mankind, the evils and miseries which the
parties bring upon themselves and entail upon their offspring in the
world, are so numerous and so frightful, and so frequently the cause of
the most terrible forms of insanity, I shall, in an after part of this
work, endeavour to embody in an essay expressly on this subject, all the
arguments which I can bring forth, for the purpose of enforcing this
first, this inmost, this greatest, grandest principle involving the
happiness and well-being of the world.
_No._ 31.—_Admitted_ 1808.—_Aged_ 30.
He is a surgeon, and was formerly in great repute as a successful
practitioner, as well as a lecturer on anatomy, surgery, and the practice
of physic.
[Picture: No. 31 page 203]
He was very studious, and chiefly during the night, though his sleep was
already sufficiently broken by his professional labour. As a young
student he was ambitious to excel, as he would often say, “I employed my
time well, that it might serve me in after life; and it did so.”
His mind is naturally one of much greater activity than power, hence his
harassing day and night practice and preparation for lecturing induced a
morbid state of mind, in which condition a fever in his family occurred.
Rapidly and unexpectedly, four male children, a niece, and a
maid-servant, were the victims, and this completed the wreck of his
overworked, active, and feeling mind.
His present state is most interesting and singular, and very difficult to
describe. His activity of mind, prodigious command of words, and most
animated and graceful manner, excite the greatest surprise; and even in
his present deranged and deluded condition, with his varied stores of
information, these exhibitions are mistaken for the remnants of
versatility of genius; yet, as I have already said, it is most true that
his mind was not naturally one of so much power as it was of amazing
ambition and activity.
He will suddenly rush into some of his anatomical, surgical, and medical
lectures, going through different parts of the human body, operations,
and practice. His lectures on the circulation of the blood, seem to have
been most strongly impressed upon his memory. At other times, his
eloquence is displayed in imitations of various celebrated characters.
If they are ancients, and he be asked, how can this be? since they lived
two thousand years ago, he says: “Yes, but I died and rose again in the
world.” And thus, he imagines himself every character he personifies,
and that at that time he was alive, and afterwards died, again
reappearing in such another character. In this way having passed through
numberless transmigrations, he was Adam, Abel, or Melchisadeck, Abraham,
Isaac, and Jacob, Moses, Joshua, Samson, Goliah, David, and Solomon.
Solomon had great attractions: frequently describing, with great
animation, his state of grandeur and enjoyment. In the same way he was
Aristotle, Pythagoras, Confucius, Plato, Zoroaster, Pliny, Ptolemy,
Cicero, Demosthenes, and particularly Homer, Mahomet, and even our
Saviour, &c. All these he will still personate, and make speeches
differing in manner and matter, and suitable in some measure to each of
them.
In medicine, all the list of celebrated men are claimed as the same
transmigration of his soul. He lifted up the serpent. He was
Hypocrates, Celsus, Galen, Paracelsus, Stahl, Van Helmont, Boerhave,
Cullen. In anatomy, surgery, chemistry, and natural philosophy, it was
the same. The whole list of celebrated medical men is monopolized by
this mania of transmigration.
He always addressed strangers as contemporaries, saying, “Good God! you
were alive at such a time: I knew you well; you were with me when I
conquered at the plains of Marathon! or, you met me at such a place when
I was singing the Iliad, as old Homer,” and so on. All this with such a
fascination of look, manner, and address, that he arrests and amuses
every one, especially strangers. He frequently talks with imaginary, and
especially angelic beings, which he does with a manner and expression
that prove he believes he beholds their actual presence.
He had a peculiarly bright and glistening eye, indicative of the secret
and destructive habit so dreadfully fatal to the insane.
It appeared to me, since amidst all this strange confusion and delusion,
his intellectual powers were still in existence, that if his
understanding could be constantly occupied, this confused condition might
in time be corrected, and his mind restored to a right state: for this
purpose I undertook to make him translate a French work, while I wrote
from his dictation, at the same time checking and controlling his wild
starts into all these vagaries. In this manner we nearly finished an
important medical work together, and he was evidently much improved by
the exercise; the task was however so amazingly arduous, that in the
midst of my other duties I was obliged to discontinue it, and he then
relapsed into his former state.
The effect, however, was sufficiently decided to prove a fact of very
great importance, and many such facts having since occurred, which
further tend to confirm that many cases which are generally given over as
incurable, may be cured by a well-directed exercise of the understanding,
by which it is at once strengthened, and the mind drawn and excluded from
the exercise of its insane feelings and hallucinations. In some cases I
have made them translate a work on the nature and effects of _their
secret vice_, and it has silently checked this habit, and at last
restored them.
* * * * *
Here I close my description of these old cases, conceiving I have given a
sufficient number for the purpose I had in view, that of exhibiting a
fair average picture of the state and character of the old insane. After
one general abstract observation on the whole essay, I shall afterwards,
and following this last case, make my next essay on the origin and nature
of disease in general, and of insanity in particular: and which I shall
do as preliminary to the more intimate and direct investigation of the
causes and nature of insanity; and especially the direct consideration of
the cause to which I have alluded in this case, because it is one of the
most general and most fatal causes of insanity, and a cause, which if not
removed, inevitably renders them incurable. Such was the habit of the
person whose case obliged me very reluctantly to assume a defensive
attitude, and refute falsehood by a statement of the truth, or otherwise
I should have continued silently to proceed in the path of duty, without
obtruding our own secret exertions on the notice of the public, as it may
appear that I have done in this essay, as well as in those which are to
follow, written, as they will be, in some measure on the same principle,
for the truth should not suffer from diffidence, any more than it ought
to be brought into disrepute by vain ostentation; still, I am quite
certain, that I am actuated by no feelings incompatible with charity and
justice.
CONCLUDING OBSERVATIONS.
The concluding general observations on this Essay and its Appendix, are,
that the one principal object I have had constantly in view, has been the
removal of the erroneous impressions and prejudices which exist almost
universally against the insane, as if they alone were all furious wild
beasts or infernal demons, and which have hitherto excited and still
continue to excite a spirit and conduct toward them, productive of a
baneful and injurious influence.
So long as these prejudices exist in the mind, even the soothing
treatment which is now so much the boast of the age, assumes a spirit and
manner, perhaps as galling and injurious to the afflicted as was,
undoubtedly, the heartless tyranny of former times.
I deprecate that altered tone of voice and manner which implies in every
word and action, that they are considered either as children, or as
beings wholly bereft of rationality.
In the system (which I have in some degree stated and explained) of
receiving and treating them as visitors, even as though they were still
rational, and of course observing towards them the same polite and
delicate attentions as are practised in well-bred society, the same
irresistible effects which precept and example always produce in every
sphere, in proportion as they are exercised in sincerity and truth, will
be found to be produced also on them; and hence we may easily perceive
how it comes to pass that we have so much greater dependence on their
attachment, good conduct, fidelity, and honour, than is generally
imagined to be possible, and why, consequently, the greater liberty which
is given them is seldom or never abused; and, as cause and effect
increase each other, it is evident that this system, by exciting and
exercising the higher feelings and moral principles of the mind,
produces, (as will be seen from the tables I shall hereafter introduce) a
much greater proportion of cures than has hitherto been the case. It is
much more conducive to cure than the system of perfect separation and
exclusion from any association. This truth is another important reason
for being anxious, from the best of motives, to remove these baneful
prejudices which have hitherto made a marked moral line of distinction
between diseases of the brain, and other parts of the system, exclusively
and absurdly making the former a proof of some shameful criminality. And
though this greater degree of well-judged liberty (not indiscriminate)
appears alarming to those who retain the usual worldly prejudices against
the insane, it is in reality attended with much less of danger or of any
thing to excite the fears of others, than most assuredly is a contrary
system.
I am now enabled, from nearly twenty years’ experience, to say this with
confidence; and I am the more anxious to impress this on the world, in
order that I may not be obliged, from too great a deference to its fears
and prejudices, to abridge the exercise of this influence, so far as to
lessen the happy effects of a system which theory and feeling have
suggested and compelled me to pursue, and which increased knowledge and
experience have confirmed and justified.
Our fears and prejudices create and realize that which would otherwise
have no existence. We often blame effects of which we ourselves are the
cause. This is one principal, if not the only, source of all our
complaints and all our troubles. Servants, children, families, sects,
parties, nations, and even the insane, are more or less good or bad in
their conduct and character, in proportion as our principles and conduct
towards them are under the influence of a wrong spirit or a right one.
Such are our views, and I trust it will be seen (the experimental part at
least,—the theory will be explained in due course) that we have
endeavoured, however imperfectly, to reduce them to practice.
Wherever natural and spiritual good exist, there we shall behold those
best fruits of charity, of which the vine and fig-tree are beautifully
appropriate emblems.
I trust that what I have advanced will be considered less as a personal
boast than as an explanatory statement, suggested by recognised evils,
and enhanced by candour and conviction. Although past conduct is the
best guarantee for the future, yet it is by no means an infallible
security; and it altogether ceases to be the test of any security, the
moment boasting, pride, or self-confidence exclude a higher and better
dependence.
* * * * *
THE END.
* * * * *
* * * * *
DEAN AND MUNDAY, PRINTERS,
THREADNEEDLE-STREET.
* * * * *
FOOTNOTES.
{vi} For the present I shall defer the publication of these Tables.
{xiii} Inferno, c. iii. 9.
{xv} See page 211.
{26} A Case and Observations being mislaid when printing, accounts for
the error in the number of this observation.
{5} See hereafter, Divisions of Insanity.
{16} See Divisions of Insanity. See also No. 131.
{18} See No. 71, 81, 88, 105, 145, 146, 175, 208, 339, 374, 375, 376,
379, 380.
{20} See Essay on a Knowledge of the Human Mind, unfolding the universal
principles of generalisation, where I shall show that these words are not
mere figures of speech, but that they each express a truth which every
fact in medicine demonstrates.
{22} It is worthy of remark, that these are those who are always ailing,
and their complaints correspond with their faulty state of mind.
{27} See the cases mentioned in Mr. Harris’s and Mr. Balle’s
affidavits,—in Allen v. Dutton.
{28} See Dr. Birkbeck’s affidavit, in Allen _versus_ Dutton.
{36} She knew me at York, when she was at the Retreat.
{55} Inferno, c. iii. 9.
{57} See No. 427.
{80} See 395 and 396.
{95} See Case No. 85.
{96} I have hitherto had but one out of 600—and he had secreted a rope,
and effected his purpose, the day after his arrival by pretending to
retire to a place of convenience.—I confess I would rather not state
this, as it may look like boasting; but so far from this, I am sure my
feelings are only those of gratitude. A suicide of a most determined
character was so delicately watched, that for six months he did not
ascertain that he had any loss of liberty, or was in a place of this
description, but merely with kind friends of his parents.
{99a} This evil is prominently seen to result from all modes of charity
that are not secret, or have not their origin or are not done in the
spirit of kindness, as well as from all punishments that are too severe
and unnecessarily degrading in their nature.
{99b} See case No. 6, in the Appendix.
{102} See Essay on Forbearance.
{114a} The organs {114d} of self esteem and benevolence, are well
developed, cautiousness defective; indeed, the whole head agrees
admirably with what I should conceive his character has been; and from
what I have seen and heard characterizes the family.
{114b} He repeats, most correctly, almost the whole of Goldsmith’s
Description of the taking of Quebec.—These cases were written in 1821.
See Essay on Atmospheric Influence.
{114c} His friends, though rich, from caprice, only allow him a very
coarse dress: in other respects, they are exceedingly attentive and kind
to him.
{114d} I think, in the present state of this science, the word—organ
objectionable, and merely to say, they are external forms representative
of internal states of mind; at the same time, I believe most firmly, that
mind can only act through organic forms created expressly for specific
uses, and even though this admits that the manifestation depends on
organic structure, yet it is best not to appear hasty, and on this
account also, I am not satisfied that the present names and divisions,
are those which time will determine, and which in nature are true.
{115} There is some partial or general defect, which renders the
operations or manifestations of mind imperfect: whether this defect, and
consequent imperfection in the manifestation of mind, arose in the first
place from bad habits, producing disorganization, or disorganization bad
habits, or from both, is not now the question. It is, however, I
believe, (the evidence on which this belief is founded, will be stated
hereafter,) generally the first.
{116} His head, upon the whole, is well formed, except that there is a
slight degree of irregularity, one side being more developed than the
other.—Cautiousness and benevolence are most prominent.—Since this was
written, two members of his family have been insane.
{117} See Table. I shall have occasion again to refer to this fact, and
have, therefore, very briefly noticed it in this place. That the
middling class are more torpid, is certain, whether wholly from their
treatment, or partly that their minds had been of a more composed habit,
or that their insanity had not arisen from violent excitements, are
interesting questions to the Medical Physiologist, and Moral
Philosopher,—which will be considered in another place.—See Mr. Jona.
Gray’s History of York Asylum.
{119a} See Observation 12.
{119b} There is a remarkable correspondence between the kind of mind he
exhibits, and the configuration of his head. It is very large and
smooth, with self-esteem, love of approbation, large; firmness, full;
combativeness, defective.
{121a} See Observation 12.
{121b} His head is small, particularly his forehead, where the
reflective organs are defective; but individuality, combativeness, and
amativeness are full; self-esteem, defective.
{122a} In this case, the organ of benevolence was exceedingly prominent,
and combativeness equally defective; indeed his whole head corresponded
most exactly with his character, and was a good one, except that one side
was more developed than the other.
{122b} His head is well formed,—benevolence, and the organs of social
feelings, particularly full, with combativeness, very defective;
ideality, very full.
{123} That he has been thousands of miles in a minute; very busy
relieving, saving, burying, or getting out of the way, (as he calls it,)
thousands of people that have been burned in some great fire—starved in
masses of ice many miles thick—or drowned in some dreadful shipwreck,
&c., &c.; some of them uncles or aunts of those he is conversing with at
the time, &c., &c.
{133a} Armies sustain immense fatigues during the excitement of a
campaign; but when the excitement is over, a prevailing epidemic will
often attack, subdue, and sometimes almost annihilate them.
{133b} In 1759, a typhus prevailed in Bethlem, and from its state at
that time, we cannot wonder at this fact. Dr. Wright, of Bethlem, says,
they have had this year a severe erysipelis attacking a great number.
It was observed of the plague of 1707, that persons excluded in religious
retirement, escaped the disease, and so did prisoners and all others kept
from the air abroad.
{134} Sydenham thought “there was some secret inexplicable alteration in
the bowels of the earth.”
{135} See Dr. Hawkin’s most valuable work on Medical Statistics.
{141} Take no pleasure in the folly of an idiot, nor in the whims and
fancies of a lunatic, nor in the phrensy of a drunkard; make them the
object of thy love and pity, not of thy pastime: when thou, alas!
beholdest them, behold how thou art indebted to Him who suffered thee not
to be like them!—Retrosp. Rev. p. 185.
{142} See Observation on Dæmonology.
{143} See pages 17 and 18.
{145a} It is a principle throughout nature, that changes, and the
repetition of changes give, in proportion to their repetition, a greater
aptitude to their periodical recurrence.—Wine merchants say, that wine
always undergoes a slight change on the annual recurrence of the original
season of its fermentation.
{145b} See pages 16, 17, & 18.
{147} See Haslam on Madness, page 236.
{151} Pinel, p. 10.
{152} This was written in 1822.
{153} In seeing the patients bathe, I have been struck with the
beautiful sleekness and clearness of their skins. Many of them, however,
retain marks of scrofula.
{154a} See No. 30.
{154b} Since the above was written, the disease of the skin was much
relieved by Ung. Hydr. Nitrat.
{155} Her head is generally good, indicating a peaceable, good-natured
being. Combativeness, defective; benevolence and philoprogenitiveness,
full.
{156a} His organ of destructiveness is very full, and the wound has been
directly there.
{156b} Firmness is very full, and combativeness rather so.
{159} His head corresponds with his character: no combativeness,
destructiveness, or caution; but self-esteem, hope, friendship, and
benevolence, full.
{160} I shall hereafter make some observations on the peculiarities of
character in females contra-distinguished from that of males.
{162} Pride, benevolence, hope, combativeness, and amativeness, full;
caution, conscientiousness, and veneration, partly defective.
{164} Philoprogenitiveness is singularly full, so is combativeness and
firmness.
{165a} He had the most immense organ of destructiveness and firmness I
ever saw, and was remarkably defective in the social feelings and
sentiments, but he had some benevolence.
{165b} His attendant says, he would have resisted harsh treatment to the
very last effort that life would allow him.
{168} His head was an immense smooth round mass, such as is common to
Epileptics, and powerful but sluggish minds.
{192} Self-esteem, love of approbation, firmness, and amativeness, are
very full; caution, causality, combativeness, are next in order;
veneration, rather defective.
{195} For remarks on religious controversy, see Essay on ‘Truth
contrasted with Error.’
{198} This I have never used since, now sixteen years ago. It is now,
under better management, wholly unnecessary, and worse than useless.
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