On this part of the subject, authors have commonly descended to minute
particularities, and studied discriminations. Distinctions have been
created, rather from the peculiar turn of the patient's propensities and
discourse, than from any marked difference in the varieties and species of
the disorder. Every person of sound mind, possesses something peculiar to
himself, which distinguishes him from others, and constitutes his
idiosyncrasy of body and individuality of character: in the same manner,
every lunatic discovers something singular in his aberrations from sanity
of intellect. It is not my intention to record these splintered
subdivisions, but to exhibit the prominent features, by which insanity may
be detected, as far as such appearances seem worthy of remark, and have
been the subject of my own observation.
In most public hospitals, the first attack of diseases is seldom to be
observed; and it might naturally be supposed, that there existed in
Bethlem, similar impediments to an accurate knowledge of incipient
madness. It is true, that all who are admitted into it, have been a
greater, or less time afflicted with the disorder; yet from the occasional
relapses to which insane persons are subject, we have frequent and
sufficient opportunities of observing the beginning, and tracing the
progress of this disease.
Among the incurables, there are some, who have intervals of perfect
soundness of mind; but who are subject to relapses, which would render it
improper, and even dangerous, to trust them at large in society: and with
those, who are upon the curable establishment, a recurrence of the malady
very frequently takes place. Upon these occasions, there is an ample scope
for observing the first attack of the disease.
On the approach of mania, they first become uneasy,[5] are incapable of
confining their attention, and neglect any employment to which they have
been accustomed; they get but little sleep, they are loquacious, and
disposed to harangue, and decide promptly, and positively upon every
subject that may be started. Soon after, they are divested of all
restraint in the declaration of their opinions of those, with whom they
are acquainted. Their friendships are expressed with fervency and
extravagance; their enmities with intolerance and disgust. They now become
impatient of contradiction, and scorn reproof. For supposed injuries, they
are inclined to quarrel and fight with those about them. They have all the
appearance of persons inebriated, and those who are unacquainted with the
symptoms of approaching mania, generally suppose them to be in a state of
intoxication. At length suspicion creeps in upon the mind, they are aware
of plots, which had never been contrived, and detect motives that were
never entertained. At last the succession of ideas is too rapid to be
examined;[6] the mind becomes crouded with thoughts, and confusion
ensues.
Those under the influence of the depressing passions, will exhibit a
different train of symptoms. The countenance wears an anxious and gloomy
aspect, and they are little disposed to speak. They retire from the
company of those with whom they had formerly associated, seclude
themselves in obscure places, or lie in bed the greatest part of their
time. Frequently they will keep their eyes fixed to some object for hours
together, or continue them an equal time "bent on vacuity." They next
become fearful, and conceive a thousand fancies: often recur to some
immoral act which they have committed, or imagine themselves guilty of
crimes which they never perpetrated: believe that God has abandoned them,
and, with trembling, await his punishment. Frequently they become
desperate, and endeavour by their own hands to terminate an existence,
which appears to be an afflicting and hateful incumbrance.
Madmen, do not always continue in the same furious or depressed states:
the maniacal paroxysm abates of its violence, and some beams of hope,
occasionally cheer the despondency of the melancholic patients. We have
in the hospital some unfortunate persons, who are obliged to be secured
the greater part of their time, but who now and then become calm, and to a
certain degree rational: upon such occasions, they are allowed a greater
range, and are admitted to associate with the others. In some instances
the degree of rationality is more considerable; they conduct themselves
with propriety, and in a short conversation will appear sensible and
coherent. Such remission has been generally termed a _lucid interval_.
When medical persons are called upon to attend a commission of lunacy,
they are always asked, whether the patient has had a _lucid interval_? A
term of such latitude as interval, requires to be explained in the most
perspicuous and accurate manner. [The circumstances which probably
occasioned the employment of this term are pointed out in the chapter
which enumerates the causes of insanity.] In common language, it is made
to signify both a moment and a number of years, consequently it does not
comprize any stated time. The term _lucid interval_ is therefore relative.
As the law requires a precise developement of opinion, I should define a
_lucid interval_ to be a complete recovery of the patient's intellects,
ascertained by repeated examinations of his conversation, and by constant
observation of his conduct, for a time sufficient to enable the
superintendant to form a correct judgment. Unthinking people, are
frequently led to conclude, that if, during a short conversation, a person
under confinement shall bewray nothing absurd or incorrect, he is well,
and often remonstrate on the injustice of secluding him from the world.
Even in common society, there are many persons whom we never suspect,
from a few trifling topics of discourse, to be shallow minded; but, if we
start a subject, and wish to discuss it through all its ramifications and
dependancies, we find them incapable of pursuing a connected chain of
reasoning. In the same manner insane people will often, for a short time,
conduct themselves, both in conversation and behaviour, with such
propriety, that they appear to have the just exercise and direction of
their faculties: but let the examiner protract the discourse until the
favourite subject shall have got afloat in the mad man's brain, and he
will be convinced of the hastiness of his decision. To those unaccustomed
to insane people, a few coherent sentences, or rational answers, would
indicate a lucid interval, because they discovered no madness; but he, who
is in possession of the peculiar turn of the patient's thoughts, might
lead him to disclose them, or by a continuance of the conversation, they
would spontaneously break forth. A beautiful illustration of this is
contained in the Rasselas of Dr. Johnson, where the astronomer is admired
as a person of sound intellect and great acquirements by Imlac, who is
himself a philosopher, and a man of the world. His intercourse with the
astronomer is frequent; and he always finds in his society information and
delight. At length he receives Imlac into the most unbounded confidence,
and imparts to him the momentous secret. "Hear, Imlac, what thou wilt not,
without difficulty, credit. I have possessed, for five years, the
regulation of weather, and the distribution of the seasons. The Sun has
listened to my dictates, and passed from tropic to tropic by my direction.
The clouds, at my call, have poured their waters, and the Nile has
overflowed at my command. I have restrained the rage of the Dog-star, and
mitigated the fervours of the Crab. The winds alone, of all the elemental
powers, have hitherto refused my authority; and multitudes have perished
by equinoctial tempests, which I found myself unable to prohibit or
restrain. I have administered this great office with exact justice, and
made to the different nations of the earth an impartial dividend of rain
and sunshine. What must have been the misery of half the globe, if I had
limited the clouds to particular regions, or confined the Sun to either
side of the Equator?"
A real case came under my observation some years ago, and which is equally
apposite to the subject. A young man had become insane from habitual
intoxication; and, during the violence of his disorder, had attempted to
destroy himself. Under a supposed imputation of having unnatural
propensities, he had amputated his penis, with a view of precluding any
future insinuations of that nature. For many months, after he was
admitted into the hospital, he continued in a state which obliged him to
be strictly confined, as he constantly meditated his own destruction. On a
sudden, he became apparently well, was highly sensible of the delusion
under which he had laboured, and conversed, as any other person, upon the
ordinary topics of discourse. There was, however, something in the reserve
of his manner, and peculiarity of his look, which persuaded me he was not
well, although no incoherence could be detected in his conversation. I had
observed him for some days to walk rather lame, and once or twice had
noticed him sitting with his shoes off, rubbing his feet. On enquiring
into the motives of his doing so, he replied, that his feet were
blistered, and wished that some remedy might be applied to remove the
vesications. When I requested to look at his feet, he declined it, and
prevaricated, saying, that they were only tender and uncomfortable. In a
few days afterwards, he assured me they were perfectly well. The next
evening I observed him, unperceived, still rubbing his feet, and then
peremptorily insisted on examining them. They were quite free from any
disorder. He now told me, with some embarrassment, that he wished much for
a confidential friend, to whom he might impart a secret of importance;
upon assuring him that he might trust me, he said, that the boards on
which he walked, (the second story) were heated by subterraneous fires,
under the direction of invisible and malicious agents, whose intentions,
he was well convinced, were to consume him by degrees.
From these considerations, I am inclined to think, that a _lucid interval_
includes all the circumstances, which I have enumerated in my definition
of it. If the person, who is to examine the state of the patient's mind,
be unacquainted with his peculiar opinions, he may be easily deceived,
because, wanting this information, he will have no clue to direct his
enquiries, and madmen do not always, nor immediately intrude their
incoherent notions: they have sometimes such a high degree of control over
their minds, that when they have any particular purpose to carry, they
will affect to renounce those opinions, which shall have been judged
inconsistent: and it is well known, that they have often dissembled their
resentment, until a favourable opportunity has occurred of gratifying
their revenge.
Of this restraint, which madmen have sometimes the power of imposing on
their opinions, the remark has been so frequent, that those who are more
immediately about their persons, have termed it, in their rude phrase,
_stifling the disorder_.
Among the numerous instances of this cunning and dissimulation, which I
have witnessed in insane persons, the relation of one case will be
sufficient to exemplify the subject.
An Essex farmer, about the middle age, had on one occasion so completely
masked his disorder, that I was induced to suppose him well, when he was
quite otherwise. He had not been at home many hours, before his
derangement was discernable by all those, who came to congratulate him on
the recovery of his reason. His impetuosity, and mischievous disposition
daily increasing, he was sent to a private mad-house; there being, at that
time, no vacancy in the hospital. Almost from the moment of his
confinement he became tranquil, and orderly, but remonstrated on the
injustice of his seclusion.
Having once deceived me, he wished much, that my opinion should be taken
respecting the state of his intellects, and assured his friends that he
would submit to my determination. I had taken care to be well prepared for
this interview, by obtaining an accurate account of the manner in which he
had conducted himself. At this examination, he managed himself with
admirable address. He spoke of the treatment he had received, from the
persons under whose care he was then placed, as most kind and fatherly: he
also expressed himself as particularly fortunate in being under my care,
and bestowed many handsome compliments on my skill in treating this
disorder, and expatiated on my sagacity in perceiving the slightest tinges
of insanity. When I wished him to explain certain parts of his conduct,
and particularly some extravagant opinions, respecting certain persons and
circumstances, he disclaimed all knowledge of such circumstances, and felt
himself hurt, that my mind should have been poisoned so much to his
prejudice. He displayed equal subtilty on three other occasions when I
visited him; although by protracting the conversation, he let fall
sufficient to satisfy my mind that he was a mad-man. In a short time he
was removed to the hospital, where he expressed great satisfaction in
being under my inspection. The private mad-house, which he had formerly so
much commended, now became the subject of severe animadversion; he said
that he had there been treated with extreme cruelty; that he had been
nearly starved, and eaten up by vermin of various descriptions. On
enquiring of some convalescent patients, I found (as I had suspected) that
I was as much the subject of abuse, when absent, as any of his supposed
enemies; although to my face his behaviour was courteous and respectful.
More than a month had elapsed, since his admission into the hospital,
before he pressed me for my opinion; probably confiding in his address,
and hoping to deceive me. At length he appealed to my decision, and urged
the correctness of his conduct during confinement as an argument for his
liberation. But when I informed him of circumstances he supposed me
unacquainted with, and assured him, that he was a proper subject for the
asylum where he then inhabited; he suddenly poured forth a torrent of
abuse; talked in the most incoherent manner; insisted on the truth of what
he had formerly denied; breathed vengeance against his family and friends,
and became so outrageous that it was necessary to order him to be strictly
confined. He continued in a state of unceasing fury for more than fifteen
months.
As the memory, appears to be particularly defective in cases of insanity,
it is much to be wished, that we possessed a correct history, and
physiological account of this wonderful faculty. Unfortunately, this
knowledge is not to be sought for with much prospect of attainment, from
books which treat of the human mind and its philosophy; nor is the present
work, to be considered as the depository of such information. A deliberate
attention, to the precise order in which we acquire information on any
subject; a consideration of the effects of its repetition; an
investigation of the result (comparing it to a chain) whenever the links
are separated, together with a knowledge of the contrivance of abbreviated
signs, would perhaps render the matter sufficiently intelligible. But it
would be necessary, thoroughly to understand the nature of the thing, of
which the sign has been abbreviated: particularly, as the usual mode of
education is satisfied with possessing the convenience of the
abbreviation, without any inquiry into the nature of the thing, and the
cause of the abbreviation of its sign. This faulty mode of instruction,
has furnished us with a profusion of names, and left us ignorant of the
things they represent.
Ben Johnson has afforded us the shortest, and probably, the best account
of memory.
"_Memory_ of all the _powers_ of the mind, is the most _delicate_, and
frail: It is the first of our _faculties_ that age invades. Seneca, the
Father, the _Rhetorician_, confesseth of himself, he had a miraculous one,
not only to receive, but to hold. I myself could in my youth, have
repeated all that ever I had made, and so continued till I was past
forty: since it is much decayed in me. Yet I can repeat whole books that I
have read, and _Poems_ of some selected friends, which I have lik'd to
charge my memory with. It was wont to be faithful to me, but shaken with
_Age_ now, and _Sloth_ (which weakens the strongest abilities) it may
perform somewhat, but cannot promise much. By exercise it is to be made
better and serviceable. Whatsoever I pawn'd with it while I was young and
a boy, it offers me readily, and without stops: but what I trust to it
now, or have done of later years, it lays up more negligently, and
sometimes loses; so that I receive mine own (though frequently called for)
as if it were new and borrow'd. Nor do I always find presently from it
what I do seek; but while I am doing another thing, that I laboured for
will come: and what I sought with trouble, will offer itself when I am
quiet. Now in some men I have found it as happy as nature, who, whatsoever
they read or pen, they can say without book presently; as if they did then
write in their mind. And it is more a wonder in such as have a swift
stile, for their Memories are commonly slowest; such as torture their
writings, and go into council for every word, must needs fix somewhat, and
make it their own at last, though but through their own
vexation."--_Discoveries, vol. vi. p. 240, 1716._
If in a chain of ideas, a number of the links are broken, or leaving out
the metaphor, if there be an inability to recollect circumstances in the
order, in which they occurred, the mind cannot possess any accurate
information. When patients of this description are asked a question, they
appear as if awakened from a sound sleep: they are searching, they know
not where, for the proper materials of an answer, and, in the painful,
and fruitless efforts of recollection, generally lose sight of the
question itself. Shakespeare, the highest authority in every thing
relating to the human mind and its affections, seems to be persuaded, that
some defect of memory is necessary to constitute madness.
"It is not madnesse
That I have uttered: bring me to the test
And I the matter will _re-word_, which madnesse
Would gambol from."--_Hamlet, Act III. Scene 4._
In persons of sound mind, as well as in maniacs, the memory is the first
power which decays; and there is something remarkable in the manner of its
decline. The transactions of the latter part of life are feebly
recollected, whilst the scenes of youth and of manhood, remain more
strongly impressed. When I have listened to the conversations of the old
incurable patients, the topic has generally turned upon the transactions
of early days; and, on the circumstances of that period of life, they have
frequently spoken with tolerable correctness. In many cases, where the
mind has been injured by intemperance, the same withering of the
recollection may be observed. It may, perhaps, arise from the mind at an
early period of life, being most susceptible and retentive of impressions,
and from a greater disposition to be pleased, with the objects which are
presented: whereas, the cold caution, and fastidiousness with which age
surveys the prospects of life, joined to the dulness of the senses, and
the slight curiosity which prevails, will, in some degree, explain the
difficulty of recalling the history of later transactions.
Insane people, who have been good scholars, after a long confinement,
lose, in a wonderful degree, the correctness of orthography: when they
write, above half the words are frequently mis-spelt, they are written
according to the pronunciation. It shews how treacherous the memory is
without reinforcement. The same necessity of a constant recruit, and
frequent review of our ideas, satisfactorily explains, why a number of
patients lapse nearly into a state of ideotism. These have, for some
years, been the silent and gloomy inhabitants of the hospital, who have
avoided conversation, and courted solitude; consequently have acquired no
new ideas, and time has effaced the impression of those, formerly stamped
on the mind. Mr. Locke, well observes, although he speaks figuratively,
"that there seems to be a constant decay of all our ideas, even of those
which are struck deepest, and in minds the most retentive; so that, if
they be not sometimes renewed by repeated exercise of the senses, or
reflection on those kind of objects, which at first occasioned them, the
print wears out, and at last there remains nothing to be seen."
Connected with loss of memory, there is a form of insanity which occurs in
young persons; and, as far as these cases have been the subject of my
observation, they have been more frequently noticed in females. Those whom
I have seen, have been distinguished by prompt capacity and lively
disposition: and in general have become the favourites of parents and
tutors, by their facility in acquiring knowledge, and by a prematurity of
attainment. This disorder commences, about, or shortly after, the period
of menstruation, and in many instances has been unconnected with
hereditary taint; as far as could be ascertained by minute enquiry. The
attack is almost imperceptible; some months usually elapse, before it
becomes the subject of particular notice; and fond relatives are
frequently deceived by the hope that it is only an abatement of excessive
vivacity, conducing to a prudent reserve, and steadiness of character. A
degree of apparent thoughtfulness and inactivity precede, together with a
diminution of the ordinary curiosity, concerning that which is passing
before them; and they therefore neglect those objects and pursuits which
formerly proved sources of delight and instruction. The sensibility
appears to be considerably blunted; they do not bear the same affection
towards their parents and relations; they become unfeeling to kindness,
and careless of reproof. To their companions they shew a cold civility,
but take no interest whatever in their concerns. If they read a book, they
are unable to give any account of its contents: sometimes, with steadfast
eyes, they will dwell for an hour on one page, and then turn over a number
in a few minutes. It is very difficult to persuade them to write, which
most readily develops their state of mind: much time is consumed and
little produced. The subject is repeatedly begun, but they seldom advance
beyond a sentence or two: the orthography becomes puzzling, and by
endeavouring to adjust the spelling, the subject vanishes. As their apathy
increases they are negligent of their dress, and inattentive to personal
cleanliness. Frequently they seem to experience transient impulses of
passion, but these have no source in sentiment; the tears, which trickle
down at one time, are as unmeaning as the loud laugh which succeeds them;
and it often happens that a momentary gust of anger, with its attendant
invectives, ceases before the threat can be concluded. As the disorder
increases, the urine and faeces are passed without restraint, and from the
indolence which accompanies it, they generally become corpulent. Thus in
the interval between puberty and manhood, I have painfully witnessed this
hopeless and degrading change, which in a short time has transformed the
most promising and vigorous intellect into a slavering and bloated ideot.
Of the organs of sense, which become affected in those labouring under
insanity, the ear, more particularly suffers. I scarcely recollect an
instance of a lunatic becoming blind, but numbers are deaf. It is also
certain that in these persons, more delusion is conveyed through the ear
than the eye, or any of the other senses. Those who are not actually deaf,
are troubled with difficulty of hearing, and tinnitus aurium. Thus an
insane person shall suppose that he has received a commission from the
Deity; that he has ordered him to make known his word, or to perform some
act, as a manifestation of his will and power. It is however much to be
regretted, that these divine commissions generally terminate in human
mischief and calamity, and instances are not unfrequent, where these holy
inspirations, have urged the unfortunate believer to strangle his wife,
and attempt the butchery of his children. From this source may be
explained, the numerous delusions of modern prophecies, which
circumstantially relate the gossipings of angels, and record the
hallucinations of feverish repose.
In consequence of some affection of the ear, the insane sometimes insist
that malicious agents contrive to blow streams of infected air into this
organ: others have conceived, by means of what they term hearkening wires
and whiz-pipes, that various obscenities and blasphemies are forced into
their minds; and it is not unusual for those who are in a desponding
condition, to assert, that they distinctly hear the devil tempting them
to self-destruction.
A considerable portion of the time of many lunatics, is passed in replies
to something supposed to be uttered. As this is an increasing habit, so it
may be considered as an unfavourable symptom, and at last the patient
becomes so abstracted from surrounding objects, that the greater part of
the day is consumed in giving answers to these supposed communications. It
sometimes happens that the intelligence conveyed, is of a nature to
provoke the mad-man, and on these occasions, he generally exercises his
wrath on the nearest bystander; whom he supposes, in the hurry of his
anger, to be the offending party.
In the soundest state of our faculties, we are more liable to be deceived
by the ear, than through the medium of the other senses: a partial
obstruction by wax, shall cause the person so affected, to hear the
bubbling of water, the ringing of bells, or the sounds of musical
instruments; and on some occasions, although the relation seems tinged
with superstition, men of undeviating veracity, and of the highest
attainments, have asserted, that they have heard themselves _called_. "He
[Dr. Johnson] mentioned a thing as not unfrequent, of which I [Mr.
Boswell] had never heard before--being _called_, that is, hearing one's
name pronounced by the voice of a known person at a great distance, far
beyond the possibility of being reached by any sound, uttered by human
organs. An acquaintance on whose veracity I can depend, told me, that
walking home one evening to Kilmarnock, he heard himself called from a
wood, by the voice of a brother who had gone to America; and the next
packet brought account of that brother's death. Macbean asserted that
this inexplicable _calling_ was a thing very well known. Dr. Johnson said,
that one day at Oxford, as he was turning the key of his chamber, he heard
his mother distinctly call _Sam_. She was then at Litchfield; but nothing
ensued. This phaenomenon is, I think, as wonderful as any other mysterious
fact, which many people are very slow to believe, or rather, indeed,
reject with an obstinate contempt."--_Boswell's Life of Dr. Johnson,
4to. vol. ii. p. 384._
One of the most curious cases of this nature which has fallen under my
observation, I shall here venture to relate, for the amusement of the
reader. The patient was a well educated man, about the middle age; he
always stopped his ears closely with wool, and, in addition to a flannel
night-cap, usually slept with his head in a tin saucepan. Being asked the
reason why he so fortified his head, he replied, "To prevent the
intrusion of the _sprites_." After having made particular enquiry
concerning the nature of these beings, he gravely communicated the
following information:--"Sir, you must know that in the human seminal
fluid there are a number of vital particles, which being injected into the
female, impregnate her, and form a foetus of muscles and bones. But this
fluid has other properties, it is capable, by itself, of producing
vitality under certain circumstances, and experienced chemists and
hermetical philosophers have devised a method of employing it for other
purposes, and some, the most detrimental to the condition and happiness of
man. These philosophers, who are in league with princes, and their
convenient and prostituted agents, contrive to extract a portion of their
own semen, which they conserve in rum or brandy: these liquors having the
power of holding for a considerable time the seminal fluid, and keeping
its vitality uninjured. When these secret agents intend to perform any of
their devilish experiments on a person, who is an object of suspicion to
any of these potentates, they cunningly introduce themselves to his
acquaintance, lull him to sleep by artificial means, and during his
slumbers, infuse a portion of their seminal fluid (conserved in rum or
brandy) into his ears.
"As the semen in the natural commerce with the woman, produces a child,
so, having its vitality conserved by the spirit, it becomes capable of
forming a _sprite_; a term, obviously derived from the spirit in which it
had been infused. The ear is the most convenient nidus for hatching these
vital particles of the semen. The effects produced on the individual,
during the incubation of these seminal germs, are very disagreeable; they
cause the blood to mount into the head, and produce considerable giddiness
and confusion of thought. In a short time, they acquire the size of a
pin's head; and then they perforate the drum of the ear, which enables
them to traverse the interior of the brain, and become acquainted with the
hidden secrets of the person's mind. During the time they are thus
educated, they enlarge according to the natural laws of growth; they then
take wing, and become invisible beings, and, from the strong ties of
natural affection, assisted by the principle of attraction, they revert to
the parent who afforded the semen, and communicate to him their
surreptitious observations and intellectual gleanings. In this manner, I
have been defrauded of discoveries which would have entitled me to
opulence and distinction, and have lived to see others reap honours and
emoluments, for speculations which were the genuine offsprings of my own
brain."
By some persons, madness has been considered as a state of mind analogous
to dreaming: but an inference of this kind supposes us fully acquainted
with the actual state, or condition of the mind in dreaming, and in
madness. The whole question hinges on a knowledge of this _state of mind_,
which I fear is still involved in obscurity. As it is not the object of
the present work to discuss this curious question, the reader is referred
to the fifth section of the first part of Mr. Dugald Stewart's Elements of
the Philosophy of the Human Mind, and to the note, o, at the end; he will
also find the subject treated with considerable ingenuity in the eleventh
section of Mr. Brown's Observations on Zoonomia.
There is, however, a circumstance, which to my knowledge, has not been
noticed by those who have treated on this subject, and which appears to
establish a marked distinction between madness and dreaming. In madness,
the delusion we experience is most frequently conveyed through the ear; in
dreaming, the deception is commonly optical; we see much, and hear little;
indeed dreaming, at least with myself, seems to be a species of
intelligible pantomime, that does not require the aid of language to
explain it. It is true, that some who have perfectly recovered from this
disease, and who are persons of good understanding and liberal education,
describe the state they were in, as resembling a dream: and when they have
been told how long they were disordered, have been astonished that the
time passed so rapidly away. But this only refers to that consciousness of
delusion, which is admitted by the patient on his return to reason; in the
same manner as the man awake, smiles at the incongruous images, and
abrupt transitions of the preceding night. In neither condition, does the
consciousness of delusion, establish any thing explanatory of the _state_
of the mind.
In a description of madness, it would be blameable to omit a form of this
disease which is commonly very intractable, and of the most alarming
consequences; I mean, the insanity which arises from the habit of
intoxication. All persons who have had any experience of this disease,
readily allow that fermented liquors, taken to excess, are capable of
producing mental derangement: but the medical practitioner has in such
cases, to contend, and generally without effect, with popular prejudice,
and sometimes, with the subordinate advisers of the law.
To constitute madness, the minds of ignorant people expect a display of
continued violence, and they are not satisfied that the person can be
pronounced in that state, without they see him exhibit the pranks of a
baboon, or hear him roar and bellow like a beast. By these people the
patient is stated only to be intemperate; they confess that he does very
foolish things when intoxicated; but that he is not mad, and only requires
to be restrained from drinking. Thus, a man is permitted slowly to poison
and destroy himself; to produce a state of irritation, which disqualifies
him for any of the useful purposes of life; to squander his property
amongst the most worthless and abandoned; to communicate a loathsome and
disgraceful disease to a virtuous wife, and leave an innocent and helpless
family to the meager protection of the parish. If it be possible, the law
ought to define the circumstances, under which it becomes justifiable, to
restrain a human being from effecting his own destruction, and involving
his family in misery and ruin. When a man suddenly bursts through the
barriers of established opinions; if he attempt to strangle himself with a
cord, to divide his larger blood-vessels with a knife, or swallow a vial
full of laudanum, no one entertains any doubt of his being a proper
subject for the superintendance of keepers, but he is allowed, without
control, by a gradual process, to undermine the fabric of his own health,
and destroy the prosperity of his family.
All patients have not the same degree of memory of what has passed during
the time they were disordered: and I have frequently remarked, when they
were unable to give any account of the peculiar opinions which they had
indulged, during a raving paroxysm of long continuance, that they well
remembered any coercion which had been used, or any kindness which had
been shewn them.
Insane people, are said to be generally worse in the morning; in some
cases they certainly are so, but perhaps not so frequently as has been
supposed. In many instances (and, as far as I have observed) in the
beginning of the disease, they are more violent in the evening, and
continue so the greatest part of the night. It is, however, a certain
fact, that the majority of patients of this description, have their
symptoms aggravated by being placed in a recumbent posture. They seem,
themselves, to avoid the horizontal position as much as possible, when
they are in a raving state: and when so confined that they cannot be
erect, will keep themselves seated upon the breech.
Many of those who are violently disordered will continue particular
actions for a considerable time: some are heard to gingle the chain, with
which they are confined, for hours without intermission; others, who are
secured in an erect posture, will beat the ground with their feet the
greatest part of the day. Upon enquiry of such patients, after they have
recovered, they have assured me that these actions afforded them
considerable relief. We often surprize persons who are supposed free from
any mental derangement, in many strange and ridiculous movements,
particularly if their minds be intently occupied:[7]--this does not
appear to be so much the effect of habit, as of a particular state of
mind.
Among the bodily particularities which mark this disease, may be observed
the protruded, and oftentimes glistening eye, and a peculiar cast of
countenance, which, however, cannot be described. In some, an appearance
takes place which has not hitherto been noticed by authors. This is a
relaxation of the integuments of the cranium, by which they may be
wrinkled, or rather gathered up by the hand to a considerable degree. It
is generally most remarkable on the posterior part of the scalp; as far as
my enquiries have reached, it does not take place in the beginning of the
disease, but after a raving paroxysm of some continuance. It has been
frequently accompanied with contraction of the iris.
On the suggestion of a medical gentleman, I was induced to ascertain the
prevailing complexion and colour of the hair in insane patients. Out of
two hundred and sixty-five who were examined, two hundred and five were of
a swarthy complexion, with dark, or black hair; the remaining sixty were
of a fair skin, and light, brown, or redhaired. What connexion this
proportion may have, with the complexion and colour of the hair of the
people of this country in general, and what alterations may have been
produced by age, or a residence in other climates, I am totally
uninformed.
Of the power which maniacs possess of resisting cold, the belief is
general, and the histories which are on record are truly wonderful: it is
not my wish to disbelieve, nor my intention to dispute them; it is proper,
however, to state that the patients in Bethlem Hospital possess no such
exemption from the effects of severe cold. They are particularly subject
to mortifications of the feet; and this fact is so well established from
former accidents, that there is an express order of the house, that every
patient, under strict confinement, shall have his feet examined morning
and evening in the cold weather by the keeper, and also have them
constantly wrapped in flannel; and those who are permitted to go about,
are always to be found as near to the fire as they can get, during the
winter season.
From the great degree of insensibility which prevails in some states of
madness, a degree of cold would scarcely be felt by such persons, which
would create uneasiness in those of sound mind; but experience has shewn
that they suffer equally from severity of weather. When the mind is
particularly engaged on any subject, external circumstances affect us less
than when unoccupied. Every one must recollect that, in following up a
favourite pursuit, his fire has burned out, without his being sensible of
the alteration of temperature; but when the performance has been finished,
or he has become indifferent to it from fatigue, he then becomes sensible
to cold, which he had not experienced before.
Some maniacs refuse all covering, but these are not common occurrences;
and it may be presumed, that by a continued exposure to the atmosphere,
such persons might sustain, with impunity, a low temperature, which would
be productive of serious injury to those who are clad according to the
exigences of the season. Such endurance of cold is more probably the
effect of habit, than of any condition peculiar to insanity.
Having thus given a general account of the symptoms, I shall now lay
before my readers a history of the appearances which I have noticed on
opening the heads of several maniacs who have died in Bethlem Hospital.