I am unable to ascertain, from any traditionary treatment of this case,
whether the habit of gyration originated in some diseased imagination; or
was merely, as I believe is more frequently the case, a habit which he
had acquired from long confinement in a small space. This habit was
common in former times, when they were confined in cells, and had no
airing grounds; and yet some writers, without attending to this
circumstance, have called it a symptom common to insanity! in this way,
many things have been called symptoms, which have been, in fact,
indications of improper treatment. The peculiar states of excitement and
depression, so striking in this case, and which is so common with the old
insane, as to have been called the chronic type of the incurable, I shall
endeavour to show, how, in many instances, it may be explained on a
different principle.
Dr. Halloran, in his practical observations on Insanity, says,—“Chronic
insanity is that form of the disease, which, having passed through the
acute and convalescent stages, has assumed the more permanent character,
and is known by the frequent exacerbation of the original accession;
also, finally, under circumstances of less violence, and with symptoms
subacute in relation to the primary affection.” He adds,—“There are few
Practioners of the most ordinary discernment, who will not feel
themselves disposed to acknowledge that cases of insanity, precisely of
this form, compose the greater majority of those committed to their
care.” He further says,—“That these paroxysms are for the most part
periodical in their approach; for though of shorter duration, they
continue pertinaciously unyielding.”
From the observations which I have to suggest, it will be seen, that I
conceive in some instances, in opposition to Dr. Halloran, and some
others, that the chronic type, or the paroxysms of some of the
permanently insane, are merely an exhibition of the irregular increase in
the stock of their animal spirits, and not an exacerbation or new
accession of the disease: and that even, in many cases, where the
alternating changes of excitement and depression are most striking, I
believe they first originated in those fluctuations of the animal
spirits, common to all of us; in some instances, it is true, (and the
case last described is one,) singularly modified, not merely by the state
of mental alienation, but by circumstances connected with their
confinement. Before, however, I endeavour to explain these singular
modifications, it appears necessary to premise some observations on one
of the causes which conspires to produce them, which cause is connected
with the atmosphere.
But as I intend to devote an Essay on Atmospheric influence, I shall
content myself with asserting, in the mean time, that there is some
common cause, or causes, assigned either to atmospherical changes, or
co-ordinate with these changes, affecting the animal spirits of the sane
and the insane—of the healthy and diseased, (in all, the manifestation is
according to individual state,) is generally, and indeed, I might perhaps
say, universally admitted, that the fact will require no further proof,
either to introduce or confirm its truth. There is then a certain
periodicity in the excitement and depression of our spirits, as well as
in all our diseases, mental or corporeal, so absolutely certain, that it
must be the conjoined effect of some order in the operations of nature,
and cannot be explained on the principle of accidental or apparent
coincidence, by which credulous and superstitious minds are often
deceived.
Though the artificial habits and constitutions of men must modify these
influences, we still, notwithstanding, often perceive the effects are
simultaneous in time, and sometimes that they preserve the same type, and
as such artificial modifications do not exist in the same degree in the
animal creation, especially in those undomesticated, on the contrary,
these influences are so uniform on them, that the signs and symptoms of
their presence are the barometers of rural life, it follows that these
very modifications in men, when rightly perceived, are additional proofs
of their being the effects of one cause.
Even in man the influence of seasons, climate, and all violent
atmospherical changes, are so striking as to be admitted by all, because
they are so powerful as to overwhelm all artificial counteracting
modifications; but, as it regards all common and minor influences, even
when the effect on the mass are coincident in time, they are in
individuals so modified by the specific habits, the state of the health,
and the peculiar state of mind, that they become so much disguised, and
of course so much less obvious to common observation, that even some
medical men will deny atmospherical influences altogether when held forth
as objects of scientific investigation, and ridicule as fanciful the man
who maintains a firm and well-grounded philosophical faith in them; this
is most inconsistent, and is like admitting a clock may mark hours, but
cannot mark minutes as they pass.—It is the child who has just discovered
the use of the hour, but not of the minute hand, of a time-piece.
The philosopher knows that the unobserved and silent influence is the
most important, and that the striking results are the mere indexes of its
secret movements.
Let ignorance pretend to admire these striking results, and laugh at him
who is anxious to discover the cause which produces them; he has
incomparably more interest and pleasure, his eyes more open, and his
understanding more exercised in these common facts, than other men, while
yet he deems them as nothing compared to the end they serve; they are
indeed interesting in themselves, but to him they are most interesting,
because he considers them the means, but still only as the means, by
which he obtains the noblest object which the light of his reason can
discover—the discovery of those principles, or of that order of operation
of the cause which produces them.
Medical libraries are full of books on the influence of seasons and
climate, miasmata, malaria, and other local causes of disease: and they
admit also that the influences of all these are such, that almost all
diseases common to man will exhibit altered and corresponding symptoms
under these varying circumstances, proving they participate in, and are
conjoined (or “tinged as it were,” as it is said by some,) with them.
All this, however, I leave for the Essay on the Atmosphere, but I mention
these facts and observations in the mean time for the sake of this
argument, that if all these modifications are admitted to exist among the
sane, how much more strikingly must the peculiar circumstances, the
singular habits, and the altered state of mind of the insane, modify the
effects of this influence:—so strikingly, that I have no doubt, from
these causes, may be explained the very singular exhibitions in this
last-mentioned case. Where the particular state of mind, and the
peculiar circumstances connected with his confinement, have superinduced
in the system the irregular accumulation and expenditure of the nervous
energy, so that, though the increase of the animal spirits was, in the
first instance, the common effect of a cause operating in and through
all, every where,—yet, operating through, and modified by, the
peculiarities connected with his case, has in time produced in him, as
well as in a less striking degree in others, and in fact, in many, though
certainly not in all cases of insanity, effects so very singular and
striking.
Again, these changes of the atmosphere, which produce these effects on
the sane, seem, on the insane, in many cases, to be wholly expended in
producing fluctuations on the animal spirits (not in bodily effects,) so
expended, as if this increase of the vital energies were neither subject
to the usual laws of corporeal nor intellectual distribution. These
insane, consequently, are less subject to disease from these causes, as
if they, no longer responsible, paid not, therefore, the price of the use
and abuse of the energies continually imparted to all. It is true, that
the life they lead, not only removes them from many causes of disease,
but the very nature of their diseased state, also, renders the mind more
susceptible of impressions, for, beside their excited state, by being
shut out from the world, they necessarily give to trifles all the
importance of weightier matters, and thus it is, that by their being the
victims of mental excitement, {133a} which is every where a protection
against prevailing diseases, they are not so liable to be attacked by the
prevailing epidemics. {133b}
Whatever influences prevail externally, they must in all cases, sane and
insane, be counteracted and modified by internal influences.
But to enter upon this investigation is not at present my intention,
therefore I shall not now examine the question, whether the epidemics of
different times, and the character of all diseases, which always partake,
more or less, of the prevailing epidemic, can be _wholly_ {134} explained
as being caused by some difference in the prevailing state of the
weather. I shall only remark that it is certain such seasons and states
of the weather are equally fruitful in the production of insanity and in
the excitement of those already insane. Yet, from these internal mental
or moral influences, it is evident that neither insanity nor epidemic
diseases can prevail exactly in proportion to the state of the weather,
unless it could be proved there always existed a correspondence between
the state of the weather and the moral and physical susceptibilities or
predisposition of the persons exposed to its influence.
At the same time I assert that our moral state has more to do with
disease, either directly or indirectly, than is generally credited, yet
these moral causes are necessarily every where physical in their
operation, so that the assertion that our physical corresponds with our
moral state, and what we call physical causes are the effects of this
state, need not alarm us, in fact, the interesting truth is now
demonstrated, {135} that health and longevity correspond with our moral
state, (though this is true as a general principle, there are many real
and apparent exceptions,) in fact, natural and moral effects co-operate,
just as the circulation depends on the nervous energy, so the nervous
energy depends greatly on our mental condition.
Whether, however, the causes of diseases are more of a mental or
corporeal character, is not now the question to decide.
For though in the Essay I propose to give on atmospheric influence, I
shall endeavour to point out the various causes which may give rise to an
irregular display of the spirits of the insane, I am far, however, from
denying, that there are alternate states of excitement and depression, of
better and worse days, which we may not be able to trace to these causes,
but which may depend on principles similar to other physical
intermittents, just as we have periodical head-aches, having their
accession and intermission most frequently every alternate day, and yet,
even in these cases, I have been able to discover the origin of these
head-aches, as was my own case, to alternate sleepless and distressing
nights. Looking at these periodical exacerbations of insanity, without
tracing them up to their first causes, they seem like the operation of
some disturbing cause, requiring a given time to arrive at their crisis,
or to produce the effect, and when produced, to subside again, and this
cause, thus viewed in its less remote operation, seems altogether of a
physical nature. But this periodicity, which I also advocate, will be
more fully examined in the third section of the Essay on Atmospheric
Influence, in which some observations will be ventured on lunar
influence.
Let the reader in the mean time take it for granted that such an
influence exists; we shall then be able to examine the modifying
influence which the peculiar state of the mind, in each, among the
insane, must have over their manner of exhibiting these alterations in
their animal spirits, especially among the old incurable cases,
labouring, as it has been said, under the chronic form of insanity.
Often, after the first attack, their minds are left in an imperfect
state; yet, notwithstanding this inability to discharge the functions of
mind properly, they generally retain their physical energies, enjoy
vigorous health, and, of course, the flow of their animal spirits
dependent thereon, is more likely to be improved than otherwise; with
respect to mind, however, they not merely want volition, and the common
motives and principles of control over themselves, but there have been
circumstances connected with their confinement, which, co-operating with
the excitement, (the cause of which I shall hereafter attempt to
explain,) have formed in the system regular periodical returns of these
states; so that, at these periods, they not only, more obviously, exhibit
these changes in their spirits, and, of course, display without disguise,
their peculiarities of mind, as children do, and sometimes as even men
do, when warmed with friendship, or with wine; but they also do so in a
higher degree, and, of course, with all their latent imperfections of
mind, in a much more striking manner; they then “show themselves,” their
peculiar character and defects; nor should this explanation of the
periodical return of these states of excitement, from the above-mentioned
co-operating causes, surprise us; we may every day witness the operation
of the same principle, among men possessed of reason.
We all know, whoever gratifies any passion, or accustoms the system to
any artificial stimulus, at stated periods, invariably finds the
difficulty of resisting this passion, and his inclination for this
stimulus greatest, at the usual period of gratification: and so it is
with the expenditure of animation; in fact, nothing is more certain, than
that both mind and body become the slave of those customs, which the
manner of our living, and moral conduct, and the circumstances through
which we have passed, have fastened around us. Now, as the circumstances
and treatment of the insane, have hitherto been different from common
life, (the object ought to be, in the treatment of the insane, to
resemble common life as much as possible;) and as they are without
control over themselves, their mode of displaying their more animated
state, must be as different from the civilized man, as the civilized man
is from the savage. If, then, habits of civilization may be called a
second nature, here it may be said, that a third has been superinduced.
From these circumstances and states of mind, it appears, that, instead of
their stock of animal spirits being expended, under the guidance of a
moral agency, and regularly diffused over their existence, they are
subject to mere physical influence, and become the sport of every eddying
wind that blows; and therefore we find every possible variety and
irregularity exhibited.—A perfect contrast to that of the good and wise
man, if such a one can be found, whose balance of mind is preserved,
whose spirits are tranquil and even, who enjoys perpetual sunshine
within, and diffuses peace and serenity around him.
Thus, because when their spirits are buoyant, they strangely exhibit
their inherent defects of mind, it has in many instances been mistaken
for an exacerbation or a returning accession of the disease, and called
the chronic type of old incurable cases.
It further appears, that this view is correct, from the fact, that if
their manner of talking and acting, in expending their increased flow of
spirits, is improperly encouraged or exasperated, then we find their
individual and latent defects become more obvious; but with proper
treatment, they gradually die away: in fact, these appearances are more
or less perceptible, in a great measure, according to the spirit and
conduct of the superintendant; and even, under him, to that of their
respective attendants. Of this, I could give some striking
illustrations. It is astonishing how much the increased flow of the
spirits will be dark, gloomy, and vindictive; or light, cheerful, and
full of kindliness; just as we by our treatment excite and keep alive one
part of the mind or another. The same principle might be illustrated
also, on a larger scale, by surveying the conduct of different parties
and governments in the world; and on a smaller scale we see every one in
authority, a magistrate, a gentleman, a minister, a pastor, the captain
of a ship, and a parent, stamp their character on the sphere in which
they move.
Were it the place, nothing could be more instructive than examples to
demonstrate the correctness of these observations.
The preceding case, I consider, is one of these examples. I have said,
that for the most part, these states of excitement and depression, are
merely an irregular exhibition in the accumulation and expenditure of the
animal spirits, and not always to be considered, according to Dr.
Halloran’s view, as the remains of the disease in the state of a
returning paroxysm, and that which characterises the permanently insane;
but that this originated in, and depended on, causes which equally affect
the animal spirits of the sane and insane, with this difference, that in
the insane, as in this case, they are modified by the peculiar state of
mind, and the sort of treatment they have received.
Grant that, from the state of his mind, any little increase of animation
would resemble, in a slight degree, that which he now exhibits, then I
am, by the help of facts, in this and some other cases of a similar
nature, justified in saying, that I have been able to trace the process
and progress of these changes, from small beginnings to their present
state. I know, from the best information, that his manner and appearance
were, when excited, so laughable and striking, that the attendants and
their friends, from want of proper feeling, or perhaps mere
thoughtlessness, actually made him a source of private sport and
amusement, and thus increased his excited state, which, in the course of
time, assumed its present peculiar and amusing form. {141}
A minute detail of all these things, together with unnecessary and
injudicious confinement, I am certain, would prove all this.
In many cases, and especially in the last, I have been able to trace, as
I have already said, the process and progress of these changes, from
small beginnings to their present state. In some cases, any little
increase of animation gave rise to manners and conversation, which were
extremely amusing, and such as tempted silly and unthinking people, as
well as the other patients, to encourage by listening or assenting too
much to them, or to exasperate by wantonly making them a source of sport
and amusement; conduct which cannot be too strongly deprecated,
especially during the critical period of their convalescence.
In most instances, however, it must be allowed, that among these old
incurable cases, {142} the most powerful exciting causes are within them.
When their minds are at all irradiated, striking ideas, and scenes of the
past, cross their imaginations; they are further excited by them; and in
proportion as the system is excited, these ideas are themselves more
powerfully awakened; they have no clear consciousness nor control over
themselves; and this dreaming state of their minds, to them all reality,
is sometimes as cheering as the dreams of hope can make it, and at other
times as horrible as the night-mare! and thus they are wrought up into
the most excited or exasperated state. In some cases, especially the
foregoing, this goes on until they are worn out, when they require a
corresponding portion of time to renew their vital energies; and thus
cause and effect mutually produce each other. These alternate states of
excitement and depression, being often repeated, they gradually increase
in strength and duration; and thus it is in some few cases, and
especially those similar to the last, we find, that their spirits are not
expended and renewed, as ours are, once in twenty-four hours, because
these changes have become the habitudes of their nature, so that their
system becomes governed by new laws of action. It is very singular that
those most liable to extremes, are most predisposed to insanity, and in
its more confirmed stage to this periodicity of excitement and
depression.
I have already noticed, {143} that the excitement of the depressing and
exhilarating passions alternately, is the most striking characteristic of
the old insane,—so striking that the general division of insanity is
intomania and melancholia; a division, however, which is altogether
unphilosophical, as the mania and melancholia are not any abstract
difference in the cause of the disease itself, but merely the results of
the over-active nervous energy operating in different directions—at one
time on the depressing, another on the exhilarating passions; this indeed
is the case, more or less, with all those who preserve not this mental
equilibrium, but who act more from the impulse of their feelings and
passions than the cold calculations of reason, and the rigid restraints
of principle. To what extremes are the passions of the human mind
liable, when neither the true light of the understanding nor any right
sense of justice guide them! We see this in ignorant and unprincipled
individuals, who suddenly rush out of their thraldom and pupilage into
liberty and licensciousness; we see the same thing exhibited by agitated
and wicked masses, as in the French Revolution, when the moral, like the
physical ocean, is let loose from its order and control, and heaves its
tumultuous waves of passion, as if by an earthquake, from one
overwhelming extreme to another.
When then, as in the insane, all the restraining powers of the mind are
lost, can we wonder that the mental energies should be subject to
accidental and baneful influences? that they should impetuously rush with
fearful, because with unguided force, into the most opposite and direful
extremes? These extremes, however, always correspond to the individual
peculiarity of mind, and the nature of the exciting causes, which
exciting causes often exist internally long before they become externally
evident; thus gradually forming ruts in those weak or soft parts of the
mind, as it were, in which their feelings are naturally more apt to run;
and thus they acquire the increasing facility and strength of habit, in
operating in one direction rather than another, until they become
irresistible: or in other words, until the understanding has no longer
the power to extricate the mind from their influence.—Body and mind have
been allowed conjointly and reciprocally to produce and increase these
effects. The effects are first, disordered action; next, inflamed and
diseased organization of the brain, as well as this disordered action
being continually strengthened by a daily increase in the power of mental
association, “calling forth an increased susceptibility to the action of
certain exciting causes;” and so far I agree with Dr. Halloran, that a
something like the original “accession of the disease,” more readily
takes place. {145a}
I have said, {145b} that in cases of permanent insanity, the alternations
into these opposite mental states occur most frequently among persons
whose previous character was marked by extremes,—who were easily excited,
and as easily depressed, either by their hopes, their fears, their anger,
or their affections. And I have often had occasion to hear these remarks
on their admission; and further, that they could not bear stimulants,
especially ardent spirits; and that there was insanity decidedly
developed during their worst paroxysms of intoxication.
In fact, the history of their lives, at least of some of them, was that
of comedy and tragedy, perpetually prophesying and exhibiting a
threatening prelude of their present more awful state; more awful in
appearance, because it has now become bereft of its former lucid
interludes; which lucid interludes had, possibly for some time, been
externally maintained only by the mere power of external moral
influences, long after the internal control had ceased to preside over
the mental operations.
We call it insanity when external restraints are broken down and
disregarded; we cannot decide how long absurd and delusive feelings and
notions have monopolized all the operations of the little world within.
I shall have occasion hereafter to adduce the history of many cases which
will serve to illustrate the truth of these views. I may briefly
mention, that they occur most frequently in those families where such a
constant April atmosphere exists: and, as a further argument it may be
stated, that a greater proportion of victims to these causes occur among
the women than among the men; and in the male sex we find they are those
of a more feminine character, or those whose feelings naturally
predominate over their understandings.
Thus children who resemble their parents, through the spirit in which
they were conceived and brought forth, become still more like them by
example and education; and hence the very important fact, that the
greater number of those who lose the power over their own minds, are from
among those who have been unaccustomed at an early stage of their
existence to exercise a salutary control over their feelings and habits;
and of those especially such as naturally possess strong animal and
sentimental feelings. Hence it is said, “that of all the causes of
mental derangement termed moral causes, perhaps the greatest number may
be traced to the error of early education.” {147} Thus, as I have
already remarked, an only child, or the youngest, (who has often as much
exclusive attachment as an only child, because he is the son of old age,
or is young when the rest cease to be children; or may be the only one
left at home,) are numerous amongst the insane.
Again, in confirmation of the same argument, we may here remark, that the
greatest number of those who become insane, become so between the ages of
thirty and forty,—a period when establishments are formed, and habits
have been strengthened by time, while the feelings yet retain all their
energy and susceptibility of action. Thus we can conceive why reverses
and disappointments should then have the most fatal and overwhelming
influence.—Still less need we wonder that this should happen to those
whose animal propensities and sentimental feelings have been exclusively
cultivated, as they then find that if understanding and principle are
insufficient to restrain them, the claims of society forbid their
gratification. Hence the conflict becomes dreadful and dangerous,
confounding and overturning the balance of the mind. Even without this,
bad passions, disjointed and exclusive habits of feeling and thinking can
hardly go on progressively increasing to this age, without becoming so
irresistible as to threaten to destroy and swallow up in their vortex all
that remains of the man within them. Such is a true and beautiful
description that Johnson has given of Imlac’s insanity in his Rasselas.
Any passion or propensity of our souls, when improperly indulged and
carried to excess, is an abnegation of reason; and in saying this, we
give a true definition of insanity, however startling this wide
application may appear.
What is the most obvious history of most cases?—Thoughts and feelings are
indulged on any given point, to the detriment or suppression of others
which might draw us from this dangerous and exclusive habit of the mind;
till at last we become incapable of resisting any other train of thought,
and feeling, and action; “they are at first imperious, and at last
despotic.”
When and how are all these evils to be best prevented? We answer, in the
preliminary stage of our existence. We shall revert to this important
subject in an essay on the primary principles of education; and shall
only now remark, that where we perceive a soil full of the seeds of all
these evils, we can expect only corresponding fruits? We shall conclude
these remarks by directing the reader to look to the soil where these
evils exist: we do this, because it exhibits the truth of the principle
for which we are contending.
We see, in the history of families, that the extremes of heartless
tyranny on the one hand, and the foolish fondness of blind affection on
the other, engender soils equally favourable to the production of these
terrible fruits to which we allude: still more so is this the case where
these extremes exist in the same family.
Many are the married persons who waste their lives in inordinately and
alternately hating and loving each other. From small beginnings, breezes
arise and gather into storms; at last, exhausted by their violence, they
subside, and for a while love returns, and all its ardent affection.
Such is the brief but sad history of many a matrimonial union,—but who
can describe its baneful influence?—how much evil and misery are
propagated! how much reason and principle, health and happiness,
reputation and prosperity, are sacrificed in those families, whose
parents thus suffer reason and understanding to be the victims of these
opposite and alternate mental states!
Of which states, such as become insane, are but the caricature samples of
the hereditary family infirmities, and the actual habits of their lives;
and perhaps this may happen to one less a hypocrite than the rest,
because in such a one, the external and internal become more easily and
readily in fixed and permanent correspondence. It is natural, therefore,
to expect that this same character will be exhibited still more
conspicuously after the understanding has altogether ceased to perform
its godlike attribute of rightly using the light of pure reason so as to
enthrone and support that one grand ruling principle to which the whole
mind should be obedient and subordinate.
I have been the more particular in making these observations, because I
conceive they may be useful in a medical point of view. They may prevent
us from mistaking the simple, though modified, changes of the natural ebb
and flow of our animal spirits, for an exacerbation or new accession of
insanity,—and thus warn us from treating the patient with unnecessary
restraint, as though he were suffering from a new attack, and from
blindly endeavouring to cure a hopeless case by the wanton administration
of strong and deleterious drugs, which in most instances would destroy
health, as well as the remnant of the faculties: “In the diseases of the
mind, as well as in all other ailments, it is an art of no little
importance, to administer medicines properly; but it is an art of much
greater and more difficult acquisition, to know when to suspend, or
altogether omit them.” {151}
_No._ 8.—_Admitted_ 1783.
No statement on record. He was a respectable country Clergyman: his
friends say he was a hard student, neglecting exercise, and all attention
to himself or his health, and which had, for some time previous to the
attack of derangement, been in a very precarious state—the attack was
very sudden and violent.
He has a leprous eruption, which has continued since the time of his
admission until now, without any very perceptibly abatement. He was
formerly the most furious maniac amongst the old incurable cases, though
less strikingly peculiar in his appearance and manners than the one last
described. During the paroxysms of his greatest fury, he appeared like
one whose mind, from excruciating pain and dreadful mental provocation,
was wrought up to the highest pitch of passion and revenge; so that he
would, as though he had the object of his malignity before him, be
incessantly repeating, through whole nights and days, some single phrase,
such as, “damn’d dog,” with a sort of suppressed barking, roaring
furiousness, even until he foamed at the mouth, and his face was black
with passion.
He was most violent when the eruption appeared least on the external
surface. When his mind was more at ease, he would play like a little
child for whole days together, with the merest trifle, such as a piece of
string or paper. At these times, when given any thing he likes, he has
something singularly fascinating in his smile.
For this eruption, many things had been administered, without any
permanent advantage. Solution of nitric acid, about three years ago,
{152} appeared to have, for a time, a good effect; the eruption became
somewhat less, and the mind less violent: but this might arise from the
debilitating effects, rather than the radical removal of the cause of his
disease. After this, the solution of nitrate of potash, had a good
effect both on his mind and the disease of his skin, without reducing or
debilitating his system. He has lived, for this last twelve months, on
vegetable diet, and he is apparently better; but this may be a fallacious
appearance, since his vital energies appear to be sinking.