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 ofaction. 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 byagitated 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 organizationof 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 ownminds, 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 insufficientto 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 primaryprinciples 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 isan 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 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.
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 eruptionsduring 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 statement on record, that gives any satisfactoryinformation. 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.
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 altogetherin 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.
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.
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 arepast 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.
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 sweepingbrush with her to bed; but now, a tin pint serves the same purpose. She is a tall, meagre-looking woman.
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 statement of her case; and I have failed in obtaining any very satisfactory information about her.
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 angerand 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 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 ablustering, 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.
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 graduallybecame 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.
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.
No. 16 page 163
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 bythat name. The great objects of her affections are cats and kittens.[164]
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 measuresseemedmore justifiable; yet nothing couldconquer 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, withouteffort, 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.
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.
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.”
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.
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.
No. 20 page 168
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 mindsenriched with laborious habits of reading and reflection!
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.
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 alow 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 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 onsubjects 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 thannecessary, 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 hismighty 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 unhingedand 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.
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 observationsON THE EFFECTS OF HEAT AND COLD AND THE STATE AND CHANGES OF TEMPERATURE IN INSANE PERSONS, which may be considered as anAppendage 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 suspensionof 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 areequally 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 individualpeculiarities.—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.
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, thesestudies 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 exactenquiry, 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 isgenerated 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 itsplace—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 thereis 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 thebonds 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 thewisdom 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 allOne, 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 theworld 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.
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 certainperiods, (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.
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 merelydisappointed, 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.
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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, andsay, 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]
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.