“Dull melancholy——She’ll make you start at ev’ry noise you hear,And visions strange shall to your eyes appear.Her voice is low, and gives a hollow sound;She hates the light, and is in darkness found;Or sits by blinking lamps, or taper small,Which various shadows make against the wall.She loves nought else but noise which discord makes,As croaking frogs whose dwelling is in lakes;The raven hoarse, the mandrake’s hollow groan,And shrieking owls, that fly i’th’ night alone;The tolling bell, which for the dead rings out,A mill, where rushing waters run about.She loves to walk in the still moonshine light,And in a thick dark grove she takes delight;In hollow caves, thatch’d houses, and low cells,She loves to live, and there alone she dwells.”
“Dull melancholy——She’ll make you start at ev’ry noise you hear,And visions strange shall to your eyes appear.Her voice is low, and gives a hollow sound;She hates the light, and is in darkness found;Or sits by blinking lamps, or taper small,Which various shadows make against the wall.She loves nought else but noise which discord makes,As croaking frogs whose dwelling is in lakes;The raven hoarse, the mandrake’s hollow groan,And shrieking owls, that fly i’th’ night alone;The tolling bell, which for the dead rings out,A mill, where rushing waters run about.She loves to walk in the still moonshine light,And in a thick dark grove she takes delight;In hollow caves, thatch’d houses, and low cells,She loves to live, and there alone she dwells.”
“Dull melancholy——She’ll make you start at ev’ry noise you hear,And visions strange shall to your eyes appear.Her voice is low, and gives a hollow sound;She hates the light, and is in darkness found;Or sits by blinking lamps, or taper small,Which various shadows make against the wall.She loves nought else but noise which discord makes,As croaking frogs whose dwelling is in lakes;The raven hoarse, the mandrake’s hollow groan,And shrieking owls, that fly i’th’ night alone;The tolling bell, which for the dead rings out,A mill, where rushing waters run about.She loves to walk in the still moonshine light,And in a thick dark grove she takes delight;In hollow caves, thatch’d houses, and low cells,She loves to live, and there alone she dwells.”
“Dull melancholy——
She’ll make you start at ev’ry noise you hear,
And visions strange shall to your eyes appear.
Her voice is low, and gives a hollow sound;
She hates the light, and is in darkness found;
Or sits by blinking lamps, or taper small,
Which various shadows make against the wall.
She loves nought else but noise which discord makes,
As croaking frogs whose dwelling is in lakes;
The raven hoarse, the mandrake’s hollow groan,
And shrieking owls, that fly i’th’ night alone;
The tolling bell, which for the dead rings out,
A mill, where rushing waters run about.
She loves to walk in the still moonshine light,
And in a thick dark grove she takes delight;
In hollow caves, thatch’d houses, and low cells,
She loves to live, and there alone she dwells.”
“There are individuals who, from various physical or moral causes,” says Esquirol, “fall into a state of corporeal torpor and mental depression. They complain of want of appetite, dull pain in the head, sense of heat in the stomach and viscera, borborygmi, and constipation of the bowels; while they exhibit little or no indication of disease. In the female sex, the natural secretions become suspended. As the complaint advances, the features alter, and the countenance exhibits anxiety; the complexion becomes pale or sallow; there is a sense of tightness, or even pain, in the epigastrium; a kind of compression in the head, which prevents them from fixing their attention, or arranging their thoughts; a general torpor or lassitude, which keeps them inactive. They dislike to move out, and love to loll about on a sofa; they are irritated if you advise them to take exercise; they abandon their ordinary avocations, neglect their domestic concerns, become indifferent to their nearest connexions; in short, they will neither converse, nor study, nor read, nor write, shunning society, and being impatient of the inquiries and importunities of friends. In this state they become filled with gloomy ideas (idées noires), despair of ever being better, desire or eveninvoke death, and sometimes destroy themselves, from a conviction that they are no longer capable of fulfilling their duties in society. These people are perfectly sane on all subjects of conversation; their impulse to suicide being strong in proportion to the activity of their former avocations, and the importance of their former duties. I have seen their disease (for it is a disease) continue for months, and even years. I have seen it alternate with mania and with perfect health. I have seen patients who would be six months of the year maniacal or in sound health, and the other six months tormented with these gloomy ideas and impulses to suicide.”
In confirmation of this view of Esquirol’s, the following cases are related:47—A gentleman of apparently sound constitution, aged 32, was married to a woman whom he affectionately loved. His affairs became deranged a few years after his marriage, which greatly discouraged him, and rendered him inactive, but without apparently affecting his health. He now embarked in a speculation which promised much advantage, and at first applied himself to business with unremitting assiduity. In the course of a month he encountered some difficulties, which depressed him beyond measure. He considered himself ruined, refused to quit his bed, and would not superintend his workmen, from a conviction that he was no longer capable of directing their operations. He complained of headache, heat in his stomach, &c. His affection for his wife and children, his pecuniary interests, all failed to rouse him from this moral and physical prostration. He reasoned sanely on the critical state of his affairs, and yet made no effort to rescue himself from his difficulties. Eight days passed in this way, when all at once he sprung from his bed in perfect integrity of mind and body. He resumed instantaneously all his activity for business, all his affection for his family. The same state, however, recurred ten or twelve times since, at irregular intervals, caused in general by trifling contrarieties of business, which, under other circumstances,would be considered as nothing. During several of these paroxysms he had impulses to suicide; but this dreaded catastrophe has not yet taken place.
A female was admitted into the Salpetriere on the 23d of September, 1819, in the 34th year of her age, and fourteen years after marriage. At the age of 21 she had a child, after which she was affected with an ulcer in the foot, which was healed in six months. From this time she was troubled with cardialgia, at first slight, but afterwards with intense pain and vomiting of her food. At the age of 33 she became irresolute in her ideas and actions. She expressed an aversion for those things which she had been previously pleased with, and was occasionally incoherent. After suffering from other derangements of her general health, she abandoned her household affairs, became quite despondent, and tried more than once to commit suicide. In this state she was admitted into the hospital, and was put upon diluents, low diet, &c. As she shewed indications of having recovered, she was allowed to return to her family; but in a short period she was harassed with gloomy ideas, despaired of recovery, and expressed a desire to quit life, the duties of which she said she was no longer able to fulfil.
In the case of Cowper, we have a melancholy instance of hypochondriasis leading to suicidal mental derangement. That the poet’s mind was unsound when he attempted to kill himself, must be evident to those who are conversant with the history of his life. He never appears to have been free from hypochondriacal disorder. In a letter to Lady Hesketh, he says, “Could I be translated to paradise, unless I could leave my body behind me, my melancholy would cleave to me there.” A friend procured him the situation of reading clerk to the House of Lords, forgetting that the nervous shyness which made a public exhibition of himself “mortal poison,” would render it impossible for him ever to discharge the duties of his office. This difficulty presented itself to the mind of the poet, and gloom instantly enveloped his faculties. At his request, his situation was changed to that of clerk of the journals; but even before he could be installed into office he was threatened with a public examination before the House. This made him completely wretched; he had not resolution to decline what he had not strength to do: the interest of his friend, and his own reputation and want of support, pressed him forward to an attempt which he knew from the first could never succeed. In this miserable state, like Goldsmith’s traveller,
“To stop too fearful, and too faint to go,”
“To stop too fearful, and too faint to go,”
“To stop too fearful, and too faint to go,”
“To stop too fearful, and too faint to go,”
he attended every day for six months at the office where he was to examine the journals in preparation for his trust. His feelings were like those of a man at the place of execution, every time he entered the office door; and he only gazed mechanically at the books, without drawing from them the least portion of information he wanted. As the time of his examination approached, his agony became more and more intense; he hoped and believed that madness would come to relieve him; he attempted also to make up his mind to suicide, though his conscience bore stern testimony against it; he could not by any argument persuade himself that it was right; but his desperation prevailed, and he procured from an apothecary the means of self-destruction. On the day before his public appearance was to be made, he happened to notice a letter in the newspaper, which to his disordered mind seemed like a malignant libel on himself. He immediately threw down the paper, and rushed into the fields, determined to die in a ditch; but the thought struck him that he might escape from the country. With the same violence he proceeded to make hasty preparations for his flight; but while he was engaged in packing his portmanteau his mind changed, and he threw himself into a coach, ordering the man to drive to the Tower wharf, intending to throw himself into the river, and not reflecting that it would be impossible to accomplish his purpose, in that public spot, unobserved. On approachingthe water, he found a porter seated upon some goods; he then returned to the coach, and drove home to his lodgings in the Temple. On the way, he attempted to drink the laudanum, but as often as he raised it, a convulsive agitation of his frame prevented its reaching his lips; and thus, regretting the loss of the opportunity, but unable to avail himself of it, he arrived half dead with anguish at his apartments. He then closed the door and threw himself on the bed, with the laudanum near him, trying to lash himself up to the deed; but a voice within seemed constantly to forbid it; and as often as he extended his hand to the poison, his fingers were contracted, and held back by spasms. At this time some of the inmates of the place came in, but he concealed his agitation; and as soon as he was left alone, a change came over him, and so detestable did the deed appear, that he threw away the laudanum, and dashed the phial to pieces. The rest of the day was spent in heavy insensibility, and at night he slept as usual; but on waking at three in the morning,he took his penknife and laid with his weight upon it, the point being directed towards his heart. It was broken, and would not penetrate. At day-break he rose, and passing a strong garter round his neck, fastened it to the frame of his bed. This gave way with his weight; but on securing it to the door, he was more successful, and remained suspended until he had lost all consciousness of existence. After a time, the garter broke, and he fell to the floor, so that his life was saved; but the conflict had been greater than his reason could endure. He felt a contempt for himself not to be expressed or imagined. Whenever he went into the street, it seemed as if every eye flashed upon him with indignation and scorn. He felt as if he had offended God so deeply that his guilt could never be forgiven, and his whole heart was filled with pangs of tumultuous despair.48
When Cowper had once admitted the thought of self-destruction, he could not go into the street without meeting with something to tempt or drive him to the act. It seemed to him as if the whole world had conspired to make death by his own hand inevitable. When he ventured into the streets, after the failure of all his efforts, a ghastly shame and alarmed suspicion were his torments; and perhaps nothing in Cowper’s autobiography goes deeper into the heart than the following description of his sufferings.
“I never went into the street but I thought the people stood and laughed at me, and held me in contempt; and could hardly persuade myself but that the voice of conscience was loud enough for any one to hear it. They who knew me, appeared to avoid me, and if they spoke to me, seemed to do it in scorn. I bought a ballad of one who was singing it in the street, because I thought it was written on me. I dined alone, either at a tavern, where I went in the dark, or at the chop-house, where I always took care to hide myself in the darkest corner of the room. I slept generally an hour in the evening, but it was only to be terrified in dreams; and when I awoke, it was some time before I could steadily walk through the passage into the dining-room. I reeled and staggered like a drunken man. The eyes of man I did not fear; but when I thought that the eyes of God were upon me, (which I felt assured of,) it gave me the most intolerable anguish. If, for a moment, a book or a companion stole away my attention from myself, a flash from hell seemed to be thrown into my mind immediately; and I said within myself, ‘What are these things to me, who am damned?’”
Cowper is not the only instance, however, of a man of exquisite taste and genius whose life has been rendered miserable by hypochondria. We have alluded elsewhere to Byron’s morbid sensitiveness, and the reader’s attention is now called tothe influence of hypochondriasis on the poet’s mind. He says in his journal, “What can be the reason I awake every morning in actual despair and despondency?” He had a great apprehension of insanity. In order to overcome his melancholy, considering that his diet had much to do with it, he put himself under a strict regimen, avoiding most scrupulously all animal food. He states that his diet for a week consisted of tea and six dry biscuits per diem. After having indulged in an ordinary dinner, he writes, “I wish to God I had not dined now; it kills me with heaviness; and yet it was but a pint of bucellas, and fish. Oh, my head! how it aches!—the horrors of indigestion!” Again he says, “This head was given me to ache with.” After a severe fit of indigestion, he writes, “I’ve no more charity than a vinegar cruet. Would that I were an ostrich, and dieted on fire-irons! O fool! I shall go mad!”
Burns suffered much from indigestion, producing hypochondria. Writing to his friend, Mr. Cunningham, he says, “Canst thou not minister to a mind diseased? Canst thou speak peace and rest to a soul tost on a sea of troubles, without one friendly star to guide her course, and dreading that the next surge may overwhelm her? Canst thou give to a frame tremblingly alive to the tortures of suspense the stability and hardihood of a rock that braves the blast? If thou canst not do the least of these, why wouldst thou disturb me in my miseries with thy inquiries after me?” From early life, the poet was subject to a disordered stomach, a disposition to headache, and irregular action of the heart.
He describes, in one of his letters, the horrors of his complaint:—“I have been for some time pining under secret wretchedness. The pang of disappointment, the sting of pride, and some wandering stabs of remorse, settle on my life like vultures, when my attention is not called away by the claims of society, or the vagaries of the muse. Even in the hour of social mirth my gaiety is the madness of an intoxicated criminal under the hands of an executioner. My constitution was blastedab originewith a deep incurable taint of melancholy that poisoned my existence.”
Nothing can be more interesting to a physician who is endowed with only a moderate share of the spirit of observation than to watch the progress of hypochondriasis in a number of patients, especially in regard to its effect on the mind. They always struggle, more or less in the beginning, with the lowness and dejection which affect them; and it is not until many a severe contest has taken place between their natural good sense and the involuntary suggestions which arise from the obscure and painful feelings of the diseased nerves, that a firm belief in the reality of such thoughts gains a full conquest over their judgment. A firm belief in any one perception never takes place until it has acquired a certain degree of force; and as all impressions which arise from the viscera of the abdomen are naturally obscure, we see the reason why these must continue for a great length of time, or be often repeated, before they can withdraw a person’s attention from the ordinary impression of external objects, which are clear and distinct, and before they acquire such a degree of vividness as to destroy the operations of reason.
We meet every day with hypochondriacs in whom the disease is just beginning to be formed, and who, being possessed of a good understanding, seem unwilling to tell, even to their medical friends, the singular, and often melancholy, thoughts with which they are tormented. They acknowledge them to be unreasonable, and yet insist that they cannot help believing in them. A very curious display of this kind of struggle between the habitudes of reason and the approach of delirium is to be found in the diary of an hypochondriac, from which we make the following extract:—
“On the 14th of November, the idea that some person intended to kill me sprung up suddenly and involuntarily in my mind, and yet, I must confess, there was no reason why I should have harboured this thought, for I am convinced that no one ever formed such a cruel design against me. Peoplewho had a stick in their hands I looked on as murderers. As I was walking out of town, a countryman happened to follow me, and I was instantly filled with the greatest apprehension, and stood still to let him pass. I asked the fellow in a threatening voice, and with a view of intimidating him from his purpose, what was the name of the town before us. The man answered my question and walked on, and I found great relief, because he was no longer behind me.
“In the evening, I observed some water in the glass out of which I commonly drink, and I instantly believed it was poisoned. I therefore washed it carefully out, and yet I knew, at the same time, that I myself had left the water in it.
“18th November.—At particular periods I believe all mankind have conspired to murder me. I think I am deprived of my office; that I am doomed to die of hunger; and, to add to all this, I am tormented with horrid doubts concerning futurity, and these thoughts persecute me like furies. Those whom I used to love most, I now hate. I avoid my best friends, and my dear wife appears to me a much worse kind of woman than she really is.
“I cannot describe the exertion it requires to conquer in society the aversion I feel to my fellow-creatures, and to prevent my ill-humour from breaking out against the most innocent people. When it really does so, I spare no one. I am sorry for it afterwards, but then I am too proud to acknowledge my error.
“I find myself so enraged on seeing a stupid, vacant countenance, that I have almost an irresistible inclination to box the person’s ears to whom it belongs: the refraining from it is a severe effort.
“20th November.—A boy with a face like a satyr met me, and occasioned me the greatest uneasiness. Although he did nothing to displease me, I was forced to go to him, and tell him that I was sure he would die on the gallows.
“23rd November.—My sensibility is often extreme, and then my best friends become insupportable to me. To theirexpressions of regard I am either purposely cold or else I answer by rude and offensive speeches. I can seldom explain to myself the reason of this too great sensibility. If two people whisper to each other in my presence, I grow uneasy, and lose all command of mind, because I think they are speaking ill of me; and I often assume a satirical manner in company, in order to frighten them. Anxiety, dreadful anxiety, seizes me, if a person overlooks my hand at cards, or if a person sits down beside me when I am playing the harpsichord.”
“From numerous facts which have come within my own observation,” says a distinguished living medical authority,49“I am convinced that many strange antipathies, disgusts, caprices of temper, and eccentricities which are considered solely as obliquities of intellect, have their source in corporeal disorder.
“The great majority of these complaints, which are considered as purely mental, such as irascibility, melancholy, timidity, and irresolution, might be greatly remedied, if not entirely removed, by a proper system of temperance, and with very little medicine. There is no accounting for the magic-like spell which annihilates for a time the whole energy of the mind, and renders the victim of dyspepsia afraid of his own shadow, or of things, if possible, more unsubstantial than shadows.
“It is not likely that the great men of the earth should be exempt from these visitations any more than the little; and if so, we may reasonably conclude, that there are other things beside ‘conscience’ which ‘make cowards of us all,’ and that, by a temporary gastric irritation, many an ‘enterprise of vast pith and moment’ has had ‘its current turned away,’ and ‘lost the name of action.’
“The philosopher and the metaphysician, who know but little of these reciprocities of mind and matter, have drawn many a false conclusion from, and erected many a baseless hypothesis on, the actions of men. Many a happy thoughthas sprung from an empty stomach; many a terrible and merciless edict has gone forth in consequence of an irritated gastric nerve. Thus health may make the same man a hero in the field whom dyspepsia may render imbecile in the cabinet.”
The following case will shew how powerfully indigestion may affect the mind’s operations:—
A young lady, after eating some heavy paste, was attacked by a sensation of burning heat at the pit of the stomach, which increased till the whole of the upper part of the body, both externally and internally, appeared to her to be all in flames. She rose up suddenly, left the dinner table, and ran into the street, from which she was immediately brought back. She soon came to herself, and thus described her horrible ideas. She declared that she had been very wicked, and had been dragged into the flames of hell. She continued in a precarious situation for some time. Whenever she experienced the burning sensation of which she first complained, the same dreadful thoughts occurred to her mind. She seized hold of whatever was nearest to prevent her from being forced away; and such was her alarm that she dreaded to be alone. This lady had long been distressed by family concerns, and harassed by restless and sleepless nights, which greatly affected her health.
Dr. Johnson used to declare that he inherited “a vile melancholy” from his father, which made him “mad all his life, or, at least, not sober.” Insanity was his constant terror. Boswell says that, at the period when this great philosopher was giving to the world proofs of no ordinary vigour of understanding, he actually fancied himself insane, or in a state as nearly as possible approaching to it.
Murphy says, “For many years before Johnson’s death, so terrible was the prospect of final dissolution that when he was not disposed to enter into the conversation which was going forward, he sat in his chair, repeating the well-known lines of Shakspeare—
“To die, and go we know not where.”
“To die, and go we know not where.”
“To die, and go we know not where.”
“To die, and go we know not where.”
Like Metastasio, he would not, if he could help it, permit the word death to be pronounced in his presence. Boswell once introduced the topic in the course of conversation, which made Johnson highly indignant. He observed, that he never had a moment in which it was not terrible to him.
Three or four days before he died, he declared that he would give one of his legs for a year more of life. The ruling passion was exhibited strong in death. At Dr. Johnson’s own suggestion, the surgeon was making slight punctures in the legs, with the hope of relieving his dropsical affection, when he cried out, “Deeper! deeper!I want length of life, and you are afraid of giving me pain, which I do not value.” If we had not a thorough conviction that this fear of death was but the result of physical disease, which no moral and religious principles could subdue, Dr. Johnson’s conduct towards the end of his life would excite a feeling in our mind towards him very opposite to that of respect.
With reference to suicide, there is no fact that has been more clearly established than that of its hereditary character. Of all diseases to which the various organs are subject, there are none more generally transmitted from one generation to another than affections of the brain. It is not necessary that the disposition to suicide should manifest itself in every generation; it often passes over one, and appears in the next, like insanity unattended with this propensity. But if the members of the family so predisposed are carefully examined, it will be found that the various shades and gradations of the malady will be easily perceptible. Some are distinguished for their flightiness of manner, others for their strange eccentricity, likings and dislikings, irregularity of their passions, capricious and excitable temperament, hypochondriasis and melancholia. These are often but the minute shades and variations of an hereditary disposition to suicidal madness. A gentleman suddenly, and without any apparent reason, cut his throat. The father had always been a man of strong passions, easily roused, and whenso, was extremely violent. The brother was a man of impulse; he always acted by fits and starts, and therefore never could be depended upon. The sister had a strange, unnatural, and superstitious horror of particular colours and odours. A yellow dress caused a feeling approaching to syncope, and the smell of hay produced great nervous excitement. The grandfather had been convicted of homicide, and had been confined for two years in a mad-house.
Andral relates the case of a father who died from the effects of disease of the brain; the mother died sane. They had six children, three boys and three girls. Of the boys, the eldest was a man of original mind; the second was very extravagant in his habits, and was ultimately confined in a mad-house; the third was extremely violent in his temper. Of the girls, one had fits of apoplexy, and became insane; the other died at her accouchement, with symptoms of derangement; the third died of cholera, not, however, until she exhibited indications of mental aberration.
A case more singular than the last is recorded. All the members of a particular family, being hereditarily disposed, exhibited, when they arrived at a certain age, a desire to commit self-destruction. It required no exciting cause to develope the fatal disposition. No wish was expressed, or attempt made, to overpower the suicidal inclination, and the greatest industry and ingenuity were exercised by the parties in order to effect their purpose. In two cases, the propensity was subdued by proper medical and moral treatment; but, just in proportion to its being suppressed, did the idea of suicide appear to fix itself resolutely in the mind. The desire came upon the individuals like the attacks of intermittent fever.
A. K., a man aged 57, was twice married. He was a shoe-maker by trade; but not having received any education, his wife was compelled to attend to all his accounts. He had experienced, when young, a blow on the head, which occasionally gave him pain. He became very intemperate in his habits, and at particular intervals he exhibited an uncontrollable temper, quarrelled with everybody, neglected his business, abused his wife, and became extravagant and melancholy. During the paroxysm he would exclaim—“Oh, my unlucky head! I am again a lost man!” When the attack subsided, he returned to his business, was affectionate to his wife and family, most humbly begged her pardon for having ill-treated her, and expressed the greatest contrition for his conduct. These attacks came on at regular intervals. He procured a piece of rope for the purpose of hanging himself, and for some months carried it about with him in his pocket for that purpose. During one of his fits he effected his object. His grandfather had strangled himself, and his brother and sister had attempted suicide.
Dr. Gall knew several families in which the suicidal propensity prevailed through several generations. Among the cases he mentions is the following very remarkable one:—“The Sieur Ganthier, the owner of various houses built without the barriers of Paris, to be used asentrepôtsof goods, left seven children, and a fortune of about two millions of francs to be divided among them. All remained at Paris, or in the neighbourhood, and preserved their patrimony; some even increased it by commercial speculations. None of them met with any real misfortunes, but all enjoyed good health, a competency, and general esteem. All, however, were possessed with a rage for suicide, and all seven succumbed to it within the space of thirty or forty years. Some hanged, some drowned themselves, and others blew out their brains. One of the first two had invited sixteen persons to dine with him one Sunday. The company collected, the dinner was served, and the guests were at the table. The master of the house was called, but did not answer; he was found hanging in the garret. Scarcely an hour before, he was quietly giving orders to the servants, and chattering with his friends. The last, the owner of a house in the Rue de Richelieu, having raised his house two stories, became frightened at the expense, imagined himself ruined, and was anxious to kill himself.Thrice they prevented him; but soon after, he was found dead, having shot himself. The estate, after all the debts were paid, amounted to three hundred thousand francs, and he might have been forty-five years old at the time of his death.”
Falret, whose researches have thrown much light on this affection, believes that it is more disposed to be hereditary than any other kind of insanity. He saw a mother and her daughter attacked with suicidal melancholy, and the grandmother of the latter was at Charenton for the same cause. An individual, he says, committed suicide in Paris. His brother, who came to attend the funeral, cried out on seeing the body—“What fatality! My father and uncle both destroyed themselves; my brother has imitated their example; and twenty times during my journey hither I thought of throwing myself into the Seine!”
Gall also relates the case of a dyer, of a very taciturn humour, who had five sons and a daughter. The eldest son, after being settled in a prosperous business with a family around him, succeeded, after many attempts, in killing himself by jumping from the third story of his house. The second son, who was rather taciturn, had some domestic troubles, lost part of his fortune at play, and strangled himself at the age of thirty-five. The third threw himself from the window into his garden, but did not hurt himself; he pretended he was trying to fly. The fourth tried one day to fire a pistol down his throat, but was prevented. The fifth was of a bilious, melancholic temperament, quiet, and devoted to business; he and his sister shewed no signs of being affected with their brothers’ malady. One of their cousins committed suicide.
Among the physical causes of self-destruction, insidious affections of the brain must stand prominently forward. It is not often that the physician is permitted to examine after death the state of this organ; but there can be no doubt that, in the great majority of instances, the brain will be found to have undergone a serious structural alteration. “During the lasttwenty-five years,” says Dr. G. Mantell, “many cases of suicide have come under my notice in which the mental hallucination which led to self-destruction has depended on lesions of the brain, occasioned by slight or neglected injuries of the head, to which neither the patient nor his friends attached any importance. In several instances of self-destruction, without any assignable moral cause, and in which no previous signs of fatuity or insanity were manifested, I have found, upon a post mortem examination, either circumscribed induration or softening of the brain, or thickening and adhesions of some portions of its membranes. The conviction was forced upon my mind that very many of theso callednervous or hypochondriacal affections, which are generally considered as imaginary and dependent on mental emotions, are ascribable to physical causes, and frequently originate from slight lesions of the brain.”
The learned doctor relates the following cases in illustration of his views:—
“A respectable tradesman, between fifty and sixty years of age, of temperate habits, was knocked down during an electioneering contest, and struck his head on the ground. He was stunned for a few minutes by the shock, and slightly bruised above the right temple, but experienced no further inconvenience, and the circumstance was considered of no consequence.
“About six months after the event, he was seized, one evening, with rigors and a pain over the right brow; a smart reaction took place, which terminated in perspiration, and the following morning, the symptoms disappeared. A similar paroxysm came on daily for five or six days; the attack was considered intermittent, and, I believe, bark was freely administered. At the end of a week, the patient was well. After this period, he was subject to occasional pain over the right brow, accompanied with great mental despondency, the prevailing apprehension being that of eternal damnation. Thisstate would continue for an uncertain time, the duration varying from a few days to three weeks; and by slow degrees he would lose all trace of disease, regain his accustomed cheerfulness, and be able to transact the affairs of an extensive business.
“About two years from the occurrence of the accident, I saw him, at the request of his friends, while he was labouring under great despondency, which his relations assured me arose from some religious opinions he had imbibed; and I found that the medical treatment had been in accordance with such a notion. My inquiries led to the detection of the injury he had received two years previously, but neither the patient nor his friends would allow that there was any connexion between the blow and the symptoms under which he now suffered. Both general and local bleeding appeared to me necessary; a strict regimen was adopted, and he regained his usual flow of spirits, and expressed himself much better than he had been for years. The occasional use of leeches, and a rigid abstinence from fermented liquors, spirits, and stimuli of all kinds, maintained this favourable condition for a considerable time; but his occupation led him to occasional excess in diet, and a moderate quantity of wine or beer invariably brought on despondency and its accompanying hallucination; in other words, when the system was kept in a tranquil state, the cerebral functions were not impaired; but when excited, the morbid manifestations of the mind were produced.
“During one of these attacks he cut his throat, and expired in the course of a few hours. A short time previous to his death, when greatly exhausted by the loss of blood from his wound, his intellect was unclouded, and he expressed to me his astonishment at what he had done, and assured me he had no reason for acting thus; but it was an impulse which he could not resist.
“The only abnormal appearance upon inspecting the body after death was, a circumscribed adhesion of the dura materto the pia mater, to the extent of about two inches in diameter, over the upper and anterior portion of the right hemisphere of the brain, opposite to the spot where the blow of the head had been inflicted some years previously.
“I will not presume to offer any comment on a case which I am well aware presents nothing unusual, my only object being that of calling particular attention to those slight injuries of the head which, although unmarked by any striking symptoms at the moment of their occurrence, may give rise to the most distressing results years after their infliction, and when the original cause of disordered action is forgotten, and can no longer be detected; and of pointing out the possibility that many cases of suicide, apparently referrible to moral causes only, may be found to result solely from physical derangement of the organ through which the manifestations of the mind must be displayed. It is under circumstances of this kind that the medical philosopher, in his painful duty of exploring the relics of mortality, may have the high gratification of protecting the memory of an unfortunate individual from the censure of a world but too apt to judge harshly, and thus afford a lasting consolation to those by whom that memory will be cherished and revered.”
No complaints can be more insidious than those connected with the brain. An apparently slight blow on the head in early life has been known, if not to give rise at the time to actual disease of the sentient organ, to predispose the person to attacks of cerebral derangement when exposed to the influence of causes so trivial as to be incapable, under any other circumstances, of producing any effect. The following case will demonstrate that moral irritation may derange the structure of the brain as effectually as any physical injury:—
A gentleman in early life was exposed for a few weeks to an amount of mental excitement almost sufficient to bring on a severe maniacal attack. He complained for some time of a sensation in his head as if some person was hammering on his brain. In the course of a few years he apparently recovered.During a tour through Italy, he had a renewal of his old sensation, and became liable to head-aches, giddiness, and severe attacks of indigestion. He placed himself under the care of an Italian physician of eminence, who did his best to restore him to health. Instead of improving, the symptoms of his disease became more apparent; and one morning he was found dead on the floor of his dressing-room, having with a penknife effectually divided the carotid artery. On examining the brain, extensiveramollissementwas discovered. In this case the structural disease originated in amoral shock, the effects of which remained suspended for some years, and then gave rise to the train of symptoms that drove the unfortunate man to terminate his life. It is one of the most important facts connected with this subject, that mental excitement may produce as extensive and serious organic disease as that which so commonly follows the receipt of physical injury. With a knowledge of this fact, how cautious we ought to be in pronouncing an opinion as to the absence of disease of the brain in cases of suicide resulting from an apparently trifling departure from mental quietude, without being intimate with the previous history of the individual.
“The English,” says Montesquieu, “frequently destroy themselves without any apparent cause to determine them to such an act, and even in the midst of prosperity. Among the Romans, suicide was the effect of education; it depended upon their customs and manner of thinking: with the English, it is the effect of disease, and depending upon the physical condition of the system.” A young man, twenty-two years of age, was intended by his parents for the church. He disliked the profession exceedingly, and absolutely refused to take orders. For this act, at once of integrity and disobedience, he was forced to quit his father’s house, and to exert his inexperienced energies for a precarious subsistence. He turned his thoughts to several different employments; and, at length, he went to reside with a family, where he was treated with great kindness, and where he appeared to enjoya degree of tranquillity. His enjoyment, however, was not of long continuance, for his imagination was assailed by gloomy and distressing reflections. His life became more and more burdensome to him, and he considered by what method he should put an end to it. He one day formed the resolution of precipitating himself from the top of the house, but his courage failed him, and the execution of the project was postponed. Some days after, he took up a pistol with the same design of self-destruction. His perplexities and terrors returned. A friend of this unhappy youth called upon Pinel one day to inform him of the projected tragedy. Every means of prevention were adopted that prudence could suggest, but the most pressing solicitations and friendly remonstrances were in vain. The propensity to suicide unceasingly haunted him, and he precipitately quitted the family from whom he had experienced so many proofs of friendship and attachment. Financial considerations prohibited the suggestion of a distant voyage or a change of climate. He was therefore advised, as the best substitute, some constant and laborious employment. The young melancholic, sensibly alive to the horror of his situation, entered fully into Pinel’s views, and procured an engagement at Bled Harbour, where he mingled with the other labourers with a full determination to deserve his stipulated wages. But, completely fatigued and exhausted by the exertion of the first two days of his engagement, he was obliged to have recourse to some other expedient. He entered into the employment of a master-mason, in the neighbourhood of Paris, to whom his services were peculiarly acceptable, as he devoted his leisure hours to the instruction of an only son. No situation, apparently, could have been more suitable to his case than one of this kind, admitting of alternate mental and bodily exercise. Wholesome food, comfortable lodgings, and every attention due to misfortune, seemed rather to aggravate than to divert his gloomy propensities. After the expiration of a fortnight, he returned to his friend, and, with tears in his eyes, acquainted him with the internal struggles which he felt, and the insuperable disgust of life, which bore him irresistibly to self-destruction. The reproaches of his friend affected him exceedingly, and, in a state of the utmost anxiety and despair, he silently withdrew, probably to terminate a hated existence by throwing himself into the Seine.
When laying down rules for the physical treatment of suicide, we have developed our view as to the influence of derangement of theprimæ viæ, suppressed secretions, &c., on the healthy state of the mind; and we have only to refer the reader to that portion of the work for information on these points. In discussing the important question whether suicide invariably results from mental derangement, numerous instances have been brought forward that may be undoubtedly traced to that cause, therefore it will not be necessary to recapitulate in this chapter what has been there advanced.
Diseases of the brain not dissimilar to affections of other organs—Early symptoms of insanity—The good effects of having plenty to do—Occupation—Dr. Johnson’s opinion on the subject—The pleasure derived from cultivating a taste for the beauties of nature—Effect of volition on diseases of the mind—Silent grief injurious to mental health—Treatment ofennui—The time of danger, not the time of disease—The Walcheren expedition—The retreat of the ten thousand Greeks under Xenophon—Influence of music on the mind in the cure of disease—Cure of epidemic suicide—Buonaparte’s remedy—How the women of Myletus were cured of the disposition to suicide, and other illustrations—Cases shewing how easily the disposition to suicide may be diverted—On the cure of insanity by stratagems—On the importance of removing the suicidal patient from his own home—On the regulation of the passions.
Intreating this most important class of affections, we must dismiss from our minds all those pre-conceived notions which we have been led to form of what constitutes mental derangement. We must view the subject as medical philosophers in the most liberal acceptation of the term, and not asnisi priusbarristers; we must consider ourselves at the bed-side of a suffering patient, demanding from our skill that relief which he is led to believe we have in our power to afford, and not as in a court of justice, undergoing an examination at the hands of a lawyer anxious to establish his case; and, above all, we must apply to the disease of the brain and its disordered manifestations those pathological principles which guide us in the elucidation of the affections of other organs. If we consider insanity not as a specific disease invariably exhibiting the same phenomena, but as it really is, the effect of a disordered condition of the sentient organ, having an incipient, as well as an advanced stage, we may, by a judicious application of the principles of therapeutics, succeed in many cases in crushing the disposition to suicide before it has taken a formidable hold of the constitution. In the great majority of cases the premonitory indications are well marked and unequivocal. The experienced physician and accurate observer will be able to detect, before the mental alienation becomes apparent to others, the early dawnings of derangement. He knows that it is frequently manifested by some change in the person’s usual healthy habits of thinking and acting,—by the exhibition of odd fancies and whims. Although surrounded by everything calculated to contribute to his happiness, he is the most miserable of human beings. Trifles annoy and irritate him; he sees in his dearest friends his deadliest enemies; talks of conspiracies, of plots, and stratagems; becomes suspicious of everything and everybody; his former objects of pleasure afford him no delight; he avoids society, and is occasionally heard muttering strange things to himself. In the majority of cases these are the early dawnings of cerebral disease leading to unequivocal insanity, and yet so tied down are we to definitions, arbitrary standards and poetical tests, that we will not admit derangement of mind to be present until the symptoms are so self evident and glaring that the condition of the mind becomes apparent to the most superficial observer. When this view of insanity is recognised as orthodox, and moral treatment adopted in the early stages of the disease, much good may be expected to result.
How often do we see in society, and during the intercourse of private friendship, individuals complaining of the severest mental sufferings, the effect of morbid alterations of feeling almost in every respect similar to insanity, dependent upon the same causes, manifesting the same symptoms, and removed by the same remedial agents. How are these mental ailmentstreated? The poor sufferer is perhaps smiled at; he is considered to be fanciful, and no regard is paid to the cerebral affection. The disease is allowed to advance until other faculties of the mind are implicated, and then the mental alienation exhibits itself so unequivocally that no one doubts its existence.
The success of the mental treatment of suicide will be mainly dependent on our paying strict attention to those apparently trifling alterations of temper and disposition, those deviations from the usual mode of thinking and acting, which so often predicate the presence of the incipient stage of insanity. An invincible love of solitude exhibited in a patient considered as labouring under an hypochondriacal affection, and who, when induced to converse, complains of being constantly pestered with one or two trains of ideas from which he cannot for a moment escape, although his efforts are great and unremitting, let his friends beware. These changes are, however, but rarely noticed, until some alarming event causes every friend to lament the want of timely attention.
Occupation is an infallible specific for many of the imaginary and real ills of life. In cases where the mind is sinking under the influence of its own weight, and the fancy is allowed to dwell uninterruptedly on the ideas of its own creation, until the individual believes himself to stand apart from all the world, the very personification of human misery and wretchedness, the physician can recommend no better remedy than constant and steady occupation for the mind and body. Burton concludes his able work on Melancholy with this valuable piece of advice:—“Be not solitary; be not idle.” Dr. Reid recommended a patient, labouring under great mental depression, to engage in the composition of a novel, which, during the time he was occupied in the task, effected much good. By interesting himself in the distresses of fictitious beings, he diverted his attention from sufferings which were no less the offspring of the imagination.
It has been suggested with great truth that the habit of gaming, prevalent as it is among persons in the upper ranks of life, is not to be attributed exclusively to a feeling of avarice. The man who is surrounded by everything to make his condition in life happy, as far as wealth is concerned, does not fly to dice for the purpose of aggrandisement, but he does so to seek refuge from the miseries of indolence and vacuity; from the gnawings of his own mind; from an eager desire to expose himself to that mental agitation which nature tells him is so necessary to make life supportable. “A woman is happier than a man,” says Dr. Johnson, “because she can hem a pocket-handkerchief.”
Our faculties, like the vulture of Prometheus, devour our souls, if they have no action beyond ourselves. “Real lassitude is always mingled with grief,” says an eminent female genius; and Madame de Staël considers the observation a profound one.
“The man in the Spectator who hanged himself to avoid the intolerable annoyance of having to tie his garters every day of his life, is but a satire on the misery of many who, having no useful occupation, find the flight of time marked only by the swift repetition of petty troubles.
“The restlessness of Rousseau, his discontented and morbidly irritable disposition, was closely allied to insanity; and the painful struggles of Lord Byron, when ‘came the fit again,’ are detailed in words which shew too plainly how they disturbed and threatened the integrity of his judgment. In such natures, every strong emotion, or the occurrence of disease, may destroy the delicate balance, and make a ruin of a mind which even in ruins continues to excite a mournful admiration. The diversion of social intercourse, which to other men is necessary to prevent mental torpor, becomes to them a source of irritation by impeding the workings of their imagination: they find that, when alone, all the nobler aspirations of the soul are free, and images of beauty, and virtue, and wisdom, occupy the mind. Society transforms them intoa being they despise, deprives them of all their high and valued thoughts, and it enables them to feel what slight circumstances, acting on the man without, may affect the man within. But the pleasures of solitude are transient; their train is followed by baseless fancies, by fears undefined, by griefs unexpressed, and black despondency, from which society can alone relieve. We learn, from observing such effects, arising from such causes, the advantage of mixed and varied occupations, suited to a being not made solely for contemplation or for action; and we may gather rules from these observations, the application of which to minds in a morbid state is very direct.”50
With no less beauty than truth has the author of Rasselas depicted the insanity of the astronomer as gradually declining under the sanative influence of society and mental gratification. The sage confesses, that since he has mixed in the gay scenes of life, and divided his hours by a succession of amusements, he found the notion of his influence over the skies gradually fade away, and began to trust less to an opinion which he could never prove to others, and which he now found subject to variations from causes in which reason had no part. “If,” says he, “I am accidentally left alone for a few hours, my inveterate persuasion rushes upon my soul, and my thoughts are chained down by an uncontrollable violence; but they are soon disentangled by the prince’s conversation, and are instantaneously released by the entrance of Pekuah. I am like a man habitually afraid of spectres, who is set at ease by a lamp, and wonders at the dread which harassed him in the dark.”
It is difficult to lay down general rules for the treatment of particular cases of melancholia with a tendency to suicide. Travelling, agreeable society, works of light literature, should be had recourse to, in order to dispel all gloomy apprehensions from the mind.
In persons predisposed to insanity, or who manifest some slight indication of disease, how important it is to endeavour to call into exercise the higher faculties of the mind,—the judgment and reasoning powers,—and thus preserve the intellectual faculties in a healthy state of equilibrium. There is much wisdom in Lord Bacon’s advice, that “if a man’s wits be wandering, he should study the mathematics.” The patient should be taught to derive a pleasure from the contemplation of those objects that afford variety, and that are always within his reach. A beneficent Creator has wisely placed around us endless sources of the purest and most elevating enjoyments. In a ratio to our intellectual attainments, so are we enabled to derive pleasure from circumstances that appear trifling and foolish to others. Mungo Park could, in the solitude of an African desert, when exposed to the most distressing circumstances, derive a most exquisite pleasure from the sight of a small flower. How fully can we enter into the feelings of the man who, after being prostrated to the earth by an accumulation of worldly disappointments, yet spoke in a tone of noble triumph at his having retained, amidst the wreck of all his hopes, a perception of the beauties of nature!