When patients are admitted into Bethlem Hospital, an enquiry is always
made of the friends who accompany them, respecting the cause supposed to
have occasioned their insanity.
It will be readily conceived, that there must be great uncertainty
attending the information we are able to procure upon this head: and even
from the most accurate accounts, it would be difficult to pronounce, that
the circumstances which are related to us, have actually produced the
effect. The friends and relatives of patients are, upon many occasions,
very delicate concerning this point, and cautious of exposing their
frailties or immoral habits: and when the disease is connected with the
family, they are oftentimes still more reserved in disclosing the truth.
Fully aware of the incorrect statement, frequently made concerning these
causes, I have been at no inconsiderable pains to correct or confirm the
first information, by subsequent enquiries.
The causes which I have been enabled most certainly to ascertain, may be
divided into PHYSICAL and MORAL.[14]
Under the first, are comprehended repeated intoxication: blows received
upon the head; fever, particularly when attended with delirium; mercury,
largely and injudiciously administered; cutaneous eruptions repelled, and
the suppression of periodical or occasional discharges and secretions;
hereditary disposition, and paralytic affections.
By the second class of causes, which have been termed _moral_, are meant
those which are supposed to originate in the mind, or which are more
immediately applied to it. Such are, the long endurance of grief; ardent
and ungratified desires; religious terror; the disappointment of pride;
sudden fright; fits of anger; prosperity humbled by misfortunes:[15] in
short, the frequent and uncurbed indulgence of any passion or emotion, and
any sudden or violent affection of the mind.
There are, doubtless, many other causes of both classes, which may tend to
produce this disease. Those which have been stated, are such as I am most
familiar with; or, to speak more accurately, such are the circumstances
most generally found to have preceded this affection.
It is an old opinion, and continues still to prevail, that maniacs are
influenced by the changes of the moon. In the fourth chapter of St.
Matthew's Gospel, verse 24, we find the word "[Greek: Seleniaxomenous]"
which is rendered in the English version, "those which were lunatic."
Notwithstanding the notion of being moon-struck might prevail among the
ignorant people of Galilee, yet Hippocrates, a philosopher, and correct
observer of natural phaenomena, does not appear to have placed any faith in
this planetary influence. Although the Romans were infected with this
popular tradition, as may be seen in the following passage of the Art of
Poetry,
"Ut mala quem scabies aut morbus regius urget,
Aut fanaticus error, et IRACUNDA DIANA
Vesanum tetigisse timent fugiuntque poetam,
Qui sapiunt:"--
yet Celsus did not consider the operation of the moon on the human
intellect sufficiently well founded to admit it into his medical work.
Not a word on this subject is mentioned in the eighteenth chapter of his
third book, which particularly treats of Insanity, "_De tribus insaniae
generibus_;" it is true that, in the fourth chapter of the first book,
which speaks "_De his quibus caput infirmum est_," he says "Cui caput
infirmum est, is si bene concoxit, leniter perfricare id mane manibus suis
debet; nunquam id, si fieri potest, veste velare; aut ad cutem tondere:
utileque lunam vitare, maximeque ante ipsum lunae solisque concursum." By
the _infirmum caput_, Celsus does not mean madness, as may be clearly seen
by perusing the chapter: the weakness of intellect, which frequently
continues after fever, or other violent diseases, is evidently his
meaning; but Dr. Cox has quoted the above passage, to prove that Celsus
was impressed with the truth of this vulgar opinion. He says, "This idea
of lunar influence, in _maniacal complaints_, was handed down to us by
our medical forefathers, and is still very generally adopted."
It is most probable that this idea of planetary regency, however it might
have arisen, or to whatever extent it may have been credited, received in
the Arabian school, the stamp by which its currency has been subsequently
maintained. For the revival and dispersion of ancient medical knowledge,
we are confessedly under considerable obligations to the Arabians;[16] and
more especially for the incorporation of astrology, magic and alchymy,
with medicine.
Popular superstitions and national proverbs, are seldom without some
foundation; and with respect to the present, it may be observed, that if
it were not in some degree rooted in fact, and trained up by observation,
it would become difficult to ascertain how such an opinion came to be
adopted; and this investigation is rendered still more important from the
consideration, that the existing law in this country, respecting insane
persons, has been established on the supposed prevalence of this lunar
regulation. A commission is issued, de _lunatico_ inquirendo, and the
commissioners sitting for that purpose, are particular in their enquiries,
whether the patient enjoys lucid intervals. The term _lucid interval_ has
been properly connected with the word _lunacy_; for, if the patient, as
they supposed, became insane at particular changes of the moon, the
inference was natural, that in the intervening spaces of time he would
become rational.
It is more than probable, that the origin of this supposition of the lunar
influence may be traced to the following circumstances. The period of the
return of the moon, and of regular menstruation in women, is four weeks;
and the terms which designate them, have been imposed from the period of
time in which both are compleated. Insanity and epilepsy are often
connected with menstruation, and suffer an exacerbation of their paroxysms
at the period when this discharge happens, or ought to take place. If,
therefore, the period of menstruation in an insane woman should occur at
the full of the moon, and her mind should then be more violently
disturbed, the recurrence of the same state may be naturally expected at
the next full moon. This is a necessary coincidence, and should be
discriminated from effect. But such has been the prevalence of this
opinion, that when patients have been brought to Bethlem hospital,
especially those from the country, their friends have generally stated
them to be worse at some particular change of the moon, and of the
necessity they were under, at those times, to have recourse to a severer
coercion. Indeed, I have understood from some of these _lunatics_, who
have recovered, that the overseer or master of the work-house himself has
frequently been so much under the dominion of this planet, and keeping
steadily in mind the old maxim, _venienti occurrite morbo_, that, without
waiting for any display of increased turbulence on the part of the
patient, he has bound, chained, flogged, and deprived these miserable
people of food, according as he discovered the moon's age by the almanack.
To ascertain how far this opinion was founded in fact, I kept, during more
than two years, an exact register, but without finding, in any instance,
that the aberrations of the human intellect corresponded with, or were
influenced by, the vicissitudes of this luminary.
As insane persons, especially those in a furious state, are but little
disposed to sleep, even under the most favourable circumstances, they will
be still less so, when the moon shines brightly into their apartments.
It has also been considered, that intellectual labour frequently becomes a
cause of insanity; that those, who are in the habit of exercising the
faculty of thought, for the perfection and preservation of the reason of
others, are thereby in danger of losing their own. We hear much of this,
from those who have copiously treated of this disease, without the toil of
practical remark; whose heads become bewildered by the gentlest exercise,
and to whom the recreation of thinking becomes the exciting cause of
stupidity or delirium. These persons enumerate, among the exciting causes
of delirium, "Too great, or too long continued exertion of the mental
faculties, as in the delirium which often succeeds long continued and
abstract calculation; and the deliria to which men of genius are
peculiarly subject."
The mind of every man is capable of a definite quantity of exertion to
good effect; all endeavours, beyond that point, are impotent and
perplexing. The attention is capable of being fixed to a certain extent,
and, when that begins to deviate, all continuance is time lost. It is
certain that, by habit, this power may be much increased; and, by frequent
exercise, that, which at first excited fatigue, may be continued with
facility and pleasure. What species of delirium is that, which succeeds
long continued and abstract calculation? Newton lived to the age of 85
years, Leibnitz to 70, and Euler to a more advanced period, yet their
several biographers have neglected to inform us, that their studies were
checquered with delirious fermentations. The mathematicians of the present
day (and there are many of distinguished eminence) would conceive it no
compliment to suppose that they retired from their labours with addled
brains, and that writers of books on insanity should impute to them
miseries which they never experienced.
It is curious to remark, in looking over a biographical chart, that
mathematicians and natural philosophers have in general attained a
considerable age; so that long continued and abstract calculation, or
correct thinking upon any subject does not appear, with all these
delirious visitations, to shorten the duration of human life. What is
meant by the deliria, to which men of genius are peculiarly subject, I am
unable, from a want of sufficient genius and delirium, to comprehend.
It is well understood, that a want of rational employment is a very
successful mode of courting delirium; that an indulgence in those reveries
which keep the imagination on the wing, and imprison the understanding, is
likely to promote it: and it must be owned, that the same effect has often
been produced, where vanity or ambition has urged minds, puny by nature,
and undrilled in intellectual exercises, to attempt to grasp that which
they were unable to embrace. This may be illustrated by the following
case.
A young gentleman of slender capacity, and very moderate education, at the
age of nineteen, was placed in a merchant's counting house, where he
continued for two years diligently, though slowly, to perform the duties
of the office. Coming at this time into the possession of considerable
property, and perhaps, aware of the uncultivated state of his own mind, he
very laudably determined to improve it. He frequented the society of
persons esteemed learned and eminent in their different professions, and
became much delighted with their conversation; but at the same time
sensible that he was unable to contribute to the discourse. He resolved to
become a severe student, and for this purpose purchased an immense
quantity of books on most subjects of literature and science. History
commenced the career of his enquiries: Rollin, Gibbon, Hume and Robertson
were anxiously and rapidly perused; but he never paused to consider, or to
connect dates and circumstances, so that these excellent authors, after he
had waded through them, left scarcely an impression on his mind. Chemistry
next engaged his attention, and on this subject, he pored over many
volumes with little advantage: the terms proved a source of embarrassment,
and he made no experiments. In a hasty succession, the ancient languages,
antiquities, etymology, agriculture, and moral philosophy, occupied his
mind. About eight hours were daily devoted to reading. Somewhat more than
two years were consumed in this employment, which had distracted his mind,
without conferring any positive knowledge.
His friends and acquaintances now began to perceive a considerable
alteration in his temper; though naturally diffident, he had assumed a
high degree of literary importance, and plumed himself on the extent of
his learning. Before this excessive, but ill-directed application, he was
a strict relator of the truth, but he now found a convenience in supplying
by fancy, that, which the indigence of his memory was unable to afford.
Shortly he began to complain that he could not sleep, and that the long
night was passed in shifting from side to side.
"Lasso, ch'n van te chiamo, et queste oscure,
Et gelide ombre in van lusingo: o piume
D'asprezza colme: o notti acerbe, et dure."
_Gio: Della Casa._
Fever succeeded, accompanied with delirium in the evening. By quietness,
and the ordinary remedies, these symptoms were removed; but he was left in
a state of extreme weakness. As he recovered from this, his habits became
materially altered: he would continue to lie in bed for several days,
after which, he would suddenly rise and walk a number of miles. Personal
cleanliness, and dress were entirely neglected: sometimes he would fast
for two or three days, and then eat voraciously. Afterwards he became
suspicious that poison had been mixed with his food. It was found
necessary to confine him, from having attempted to castrate himself: this
he afterwards effected in a very complete manner, and continues a maniac
to the present time.
Few persons, I believe, will be disposed to consider the above case, as an
instance of insanity succeeding to a laborious exercise of the
intellectual faculties. It is true, he was busied with books: but this
occupation could not have strained his mind, for he appears neither to
have comprehended, nor retained any of the objects of his pursuit.
_Hereditary Disposition._
"Ut male posuimus initia sic cetera sequuntur."--_Cicero._
"Whatever was in the womb imperfect, as to her proper work, comes very
rarely, or never at all, to perfection afterwards."--_Harrington's
Works, p. 177._
Considerable diversity of opinion has prevailed, whether insanity be
hereditary or not; and much has been said on both sides of this question.
Great ingenuity has been exerted to prove that this disease is accidental,
or that there are sufficient causes to account for its occurrence, without
supposing it one of those calamities that "_flesh is heir to_." It has
been argued, that, if the disease were hereditary, it ought uniformly to
be so, and that the offspring of a mad parent should necessarily become
insane.
All theories and reasonings appear to be good for as much as they prove;
and if the term _hereditary_ be employed with a degree of strictness, so
as to denote certain and infallible transmission, such inevitable descent
cannot be defended. Several instances have come under my observation where
the children of an insane parent have not hitherto been affected with
madness, and some have died early in life, without having experienced any
derangement of mind. More time is therefore required.
All observations concur in acknowledging that there are many circumstances
in which children resemble their parents. It is very common to see them
resemble one of their parents in countenance, and when there are several
children, some shall bear the likeness of the father and others of the
mother. Children often possess the make and fashion of the body, peculiar
to one or other of their parents, together with their gait and voice; but
that which has surprized me most is the resemblance of the hand-writing.
If a parent had taught his son to write, it might be expected that a
considerable similarity would be detected; but in general the fact appears
to be otherwise, for it seldom happens that the scholars, though
constantly imitating the copy of the master, write at all like him, or
like each other. In a few instances I have noticed a correct resemblance
between the hand-writing of the father and son, where the former died
before the latter had been taught the use of the pen, and who probably
never saw the hand-writing of his father. The transmission of personal
deformities is equally curious. I am acquainted with a person in this
town, whose middle and ring finger are united, and act as one; all the
children of this man carry the same defect. A toenail, particularly
twisted, has been traced through three generations, on the same foot and
toe. Abundant instances might be adduced on this subject; there is
scarcely a family which cannot produce something in confirmation; and if
to these circumstances in the human species, were to be added the
experiments which have been made on the breeding of cattle, perhaps
little doubt would remain.
The reasoners against the transmission of madness urge, that, if the
contrary were true, we should by this time have detected the rule or law
by which nature acts, and that we should have been able to
determine,--First, whether the disorder descended to the male or female
children accordingly as the father or mother was affected.--Secondly,
which of the parents is most capable of transmitting the
disease?--Thirdly, what alternations in the succession take place, does it
shift from the male to the female line, and, does it miss a generation,
and afterwards return?
These, and a multitude of other queries, might be proposed; I believe much
faster than they could be answered. Nature appears to delight in producing
new varieties, perhaps less in man than in other animals, and still less
in the animal than in the vegetable kingdom. Before these subtile
reasoners expect, from those who maintain that madness generally descends
from the parent to the offspring, a developement of the laws by which
Nature acts, it would be convenient first to settle whether in this matter
she be under the dominion of any law whatever.
The investigation of the hereditary tendency of madness is an object of
the utmost importance, both in a legal and moral point of view. Parents
and guardians, in the disposal, or direction of the choice of their
children in marriage, should be informed, that an alliance with a family,
where insanity has prevailed, ought to be prohibited.
Having directed some attention to enquiries of this nature, I am enabled
truly to state, that, where one of the parents have been insane, it is
more than probable that the offsprings will be similarly affected.
Madness has many colours, and colours have many hues; actual madness is a
severe calamity, yet experience has pointed out the treatment, and the law
has permitted the imposition of the necessary restraint: but it very
frequently occurs that the descendants from an insane stock, although they
do not exhibit the broad features of madness, shall yet discover
propensities, equally disqualifying for the purposes of life, and
destructive of social happiness.
The slighter shades of this disease include eccentricity, low spirits, and
oftentimes a fatal tendency to immoral habits, notwithstanding the
inculcation of the most correct precepts, and the force of virtuous
example.
In illustration of the fact, that the offsprings of insane persons are,
_ceteris paribus_, more liable to be affected with madness than those
whose parents have been of sound minds; it was my intention to have
constructed a table, whereon might be seen the probably direct course of
this disease, and also its collateral bearings: but difficulties have
arisen. It appeared, on consideration, improper to attempt precision with
that which was variable, and as yet unsettled; I have therefore been
content to select a few histories from my book of notes, and to exhibit
them in the rude state in which they were set down.
_1st._--R. G. His grandfather was mad, but there was no insanity in his
grandmother's family. His father was occasionally melancholic, and once
had a raving paroxysm. His mother's family was sane. His father's brother
died insane. R. G. has a brother and five sisters; his brother has been
confined in St. Luke's, and is occasionally in a low spirited state. All
his sisters have been insane; with the three youngest the disease came on
after delivery.
_2d._--M. M. Her grandmother was insane and destroyed herself. Her father
was mad for many years, but after the birth of all his children. M. M. has
two brothers and a sister; both her brothers have been insane; the sister
has never been so affected, but was a person of loose character. The
insanity of M. M. was connected with her menstruation; after its cessation
she recovered, although she had been confined more than sixteen years.
_3d._--M. H. Her father had been several times insane; her mother was
likewise so affected a few months before her death. Afterwards her father
married a woman perfectly sane, by whom he had three children, two female
and a male; both the females are melancholic, the male was a vicious
character, and has been transported. M. H. has had ten children, three
have died with convulsions, the eldest, a girl, is epileptic.
_4th._--T. B. His mother became insane soon after being delivered of him,
and at intervals has continued so ever since. He has a brother who became
furiously mad at the age of twenty, and afterwards recovered. T. B.'s
disorder came on at the age of twenty-six.
_5th._--S. F. Her father's mother was insane, and confined in the
hospital. Her father never discovered any symptoms of insanity, and her
mother was perfectly sane. Her only sister (she had no brothers) was mad
about five years ago, and recovered. S. F. has been twice in the hospital.
_6th._--P. W. After the best enquiries it does not appear that her father
or mother ever experienced any attack of madness or melancholy. P. W.'s
disorder commenced shortly after the delivery of a child. She has three
sisters, the eldest has never been married, and has hitherto continued of
sound mind. The two younger have been mothers, and in both insanity has
supervened on childbearing.
_7th._--J. A. H. His father's father was insane, and his father was also
disordered, and destroyed himself. His mother was of sound mind. J. A. H.
became insane at the age of twenty-three. He has two sisters, the elder
has once been confined for insanity, the younger is of weak intellects,
nearly approaching to ideotism.
_8th._--M. D. Her mother was insane and died so. M. D. continued of sane
mind until she had attained the age of fifty-seven, when she became
furiously maniacal; her only daughter, eighteen years of age, was attacked
with mania during the time her mother was confined.
_9th._--G. F. His mother was melancholic during the time she was pregnant
with him, and never afterwards completely recovered. She had five children
previously to this melancholic attack, who have hitherto continued of
sound mind. She bore another son after G. F. who is extremely flighty and
unmanageable. G. F. was attacked with madness at the age of nineteen, and
died apoplectic, from the violence and continued fury of his disorder.
_10th._--M. T. Her mother was of sound mind. Her father was in a
melancholic state for two years, before she was born, but this was
afterwards dissipated by active employment. M. T. has two brothers,
younger than herself, who have been attacked with insanity, neither of
whom have recovered. She has two sisters, some years older than herself,
these have never been deranged. M. T. has had nine children. The three
first have been melancholic. The youngest, at the age of five years, used
to imagine she saw persons in the room covered with blood, and other
horrible objects, she afterwards became epileptic and died. The youngest
of her three first children has been married and had three children, one
of whom is afflicted with chorea Sancti Viti, and another is nearly an
ideot.
Of the causes termed moral, the greatest number may, perhaps, be traced to
the errors of education, which often plant in the youthful mind those
seeds of madness which the slightest circumstances readily awaken into
growth.
It should be as much the object of the teachers of youth, to subjugate the
passions, as to discipline the intellect. The tender mind should be
prepared to expect the natural and certain effects of causes: its
propensity to indulge an avaricious thirst for that which is unattainable,
should be quenched: nor should it be suffered to acquire a fixed and
invincible attachment to that which is fleeting and perishable.
Of the more immediate, or, as it is generally termed, the proximate cause
of this disease, I profess to know nothing. Whenever the functions of the
brain shall be fully understood, and the use of its different parts
ascertained, we may then be enabled to judge, how far disease, attacking
any of these parts, may increase, diminish, or otherwise alter its
functions. But this is a degree of knowledge, which we are not likely soon
to attain. It seems, however, not improbable, that the only source, from
whence the most copious and certain information can be drawn, is a strict
attention to the particular appearances which morbid states of this organ
may present.
From the preceding dissections of insane persons, it may be inferred, that
madness has always been connected with disease of the brain and of its
membranes. Having no particular theory to build up, they have been related
purely for the advancement of science and of truth.
It may be a matter, affording much diversity of opinion, whether these
morbid appearances of the brain be the cause or the effect of madness: it
may be observed that they have been found in all states of the disease.
When the brain has been injured from external violence, its functions have
been generally impaired, if inflammation of its substance, or more
delicate membranes has ensued. The same appearances have for the most part
been detected, when patients have died of phrenitis, or in the delirium of
fever: in these instances, the derangement of the intellectual functions
appears evidently to have been caused by the inflammation. If in mania the
same appearances be found, there will be no necessity of calling in the
aid of other causes, to account for the effect: indeed, it would be
difficult to discover them.
Those who entertain an opposite opinion are obliged to suppose, _a disease
of the mind_. Such a morbid affection, from the limited nature of my
powers, perhaps I have never been able to conceive. Possessing, however,
little knowledge of metaphysical controversy, I shall only offer a few
remarks upon this part of the subject, and beg pardon for having at all
touched it.
Perhaps it is not more difficult to suppose, that matter, peculiarly
arranged, may _think_,[17] than to conceive the union of an immaterial
being with a corporeal substance. It is questioning the infinite wisdom
and power of the Deity to say, that he does not, or cannot, arrange matter
so that it shall think. When we find insanity, as far as has been hitherto
observed, uniformly accompanied with disease of the brain, is it not more
just to conclude, that such organic affection has produced this incorrect
association of ideas, than that a being, which is immaterial,
incorruptible, and immortal, should be subject to the gross and
subordinate changes which matter necessarily undergoes?
But let us imagine _a disease of ideas_. In what manner are we to effect a
cure? To this subtle spirit the doctor can apply no medicines. Though so
refined as to elude the force of material remedies, some may however think
that it may be reasoned with. The good effects which have resulted from
exhibiting logic as a remedy for madness, must be sufficiently known to
every one who has conversed with insane persons, and must be considered as
time very judiciously employed: speaking more gravely, it will readily be
acknowledged, by persons acquainted with this disease, that, if insanity
be a disease of ideas, we can possess no corporeal remedies for it: and
that an endeavour to convince madmen of their errors, by reasoning, is
folly in those who attempt it, since there is always in madness the
firmest conviction of the truth of what is false, and which the clearest
and most circumstantial evidence cannot remove.