INSANITY.
It is not the object of this chapter to treat at large of insanity.
It is my intention to speak, as briefly as possible, of some points
in regard to its causes and its treatment, which ought to be
understood by the community.
The causes of insanity may be divided into two classes—those which
act upon the mind, and those which act upon the body.
The mental causes of insanity do not produce the disease directly
through their influence upon the mind. But this influence extends to
the organization with which the mind is connected; and the insane
manifestations or symptoms are entirely the result of the reaction
of the affected organization upon the mind. As this point has been
somewhat fully elucidated in the chapter on _the Mutual Influence of
Mind and Body in Disease_, it is not necessary to dwell upon it here.
The physical causes of insanity may be subdivided into three classes;
those which act upon the great central organ of the mind, the brain;
those which produce disease in other organs, affecting the brain
sympathetically; and those which have a more general influence upon
the system as a whole, or as a congeries of organs. In an individual
predisposed to insanity by the peculiar cast of his nervous system,
this malady may be induced by some local disease of some of the
organs, or by an impaired state of the general health.
There is commonly too much disposition to look to some one thing,
as the cause of the insanity in each individual case. And this
disposition is encouraged by the tables of causes, which appear in
some of the reports which are issued from our Insane Hospitals.
These tables cannot be made up with any degree of correctness. They
are therefore of little, if any, use; and they are even calculated
to lead to error, if any great reliance be placed upon them. In the
great majority of cases of insanity, the disease is the result of a
concurrence of causes, and not of one cause alone. Perhaps it will
be said, that in constructing these tables the _predominant_ cause
is sought for in each case. If it be, it is by no means always easy
to find it. In very many cases there must be much doubt in regard
to it; and in no small proportion of them candor would lead to the
confession, that we are entirely in the dark on this question. In the
classification of causes, the class of _doubtful_ or _unknown_ should
be much more numerous than it usually is in the annual reports of
Institutions for the Insane.
One of the mistakes which are committed by the community, and
sometimes even by physicians, in regard to the causes of insanity,
deserves a passing notice. The _form_ of the derangement is often
considered as indicative of the nature of its cause. It is by
no means necessarily so. For example, an individual, who in his
derangement talks mostly on the subject of religion, cannot as a
matter of course be considered as having become insane through
religious excitement. It may have been so, but the bare fact, that
religion furnishes the subjects of his insane ideas and feelings, is
no absolute proof that it is so. As well might it be said, that a
patient who thinks that he has no stomach, of course became insane
through abuse of that organ. A very common cause of insanity of a
religious character is an impaired state of the general health; and
the insane ideas run in that particular channel very often from the
influence of merely collateral, or adventitious circumstances.
Neither can the form of the derangement furnish any conclusive
evidence as to the character of the patient. Persons of the purest
minds, and of the deepest reverence for the Deity, are sometimes in
their insanity exceedingly profane and obscene.
It is important that the public should be informed in relation to
the _causes_ of insanity, in order that these causes may as far as
possible, be avoided. I will therefore notice some of them very
briefly.
One of the causes of insanity is an indulgence of the passions.
I take as an example the passion of pride. When this passion
has obtained a monstrous growth from long indulgence, a severe
mortification of it, especially if it be repeated or continued,
will produce insanity in those who are predisposed to this disease,
and sometimes in those who have no marked predisposition of this
character. Many cases of this kind may be found in our Retreats.
In this connection I mention, as another source of insanity,
the wrong views of life, the false principles, and the sickly
sentimentalism, which are infused insensibly into the mind by a very
large proportion of the fictitious literature of the world. This
influence is a more prolific source of insanity than is commonly
supposed. Not only is it exerted upon the reader as an individual,
but it affects through the multitude of readers the general tone
of thought and feeling, and thus acts widely, not merely as a
particular, but as a general cause of insanity.
Anything which causes an undue excitement in the mind has a tendency
to produce insanity. A too exclusive and prolonged attention to one
subject has this effect. It is in this way in part that ultraism
acts as a cause of this disease. The brain becomes wearied out and
weakened by one kind of effort, just as the muscles of the school
boy’s arm are tired out, when, as a punishment, he is compelled to
hold with outstretched arm any heavy article for some considerable
length of time. A wearied and weakened brain, when the infliction
which produces this result, is frequent and long continued, is apt
to become diseased; and one of the diseases to which it is thus made
liable is insanity.
It is said that insanity is hardly known among the savage and
uncivilized. There are two reasons for this. They are the
intellectual torpor, and the physical vigor, which result from the
habits of the savage. Wild passion, it is true, sometimes lashes his
mind into fury, but it easily subsides into its usual repose, and the
firm fibres of the brain and nerves suffer no injury from the shock.
So also in countries which are ruled by despotic governments, the
mental torpor which prevails makes insanity a rare disease.
As the intellectual torpor and the physical vigor of savage life
prevent the occurrence of insanity; so on the other hand, the
intellectual activity and the physical debility of civilized life
conduce to its existence. Mental excitement combined with luxury and
effeminacy is a prolific source of this disease. In this age, and
especially in this nation, the mental activities in every department
of effort are so lively, and have so little intervals of relaxation,
that the wear and tear of brain in all this conflict produce an
unusual amount of insanity, greater as is shown by statistics, than
in any other country in the world.
It is not strange that the excitement which is created in the mind by
the stirring motives presented by religion, should sometimes occasion
mental derangement. The struggle which it often awakens against
the passions, and propensities, and errors, which have accumulated
in amount and force by long indulgence in sin, must render persons
of considerable nervous susceptibility liable to this disease. But
in such cases religion acts only as the exciting cause, while the
predisposing causes have been exerting their influence through a long
series of years. And it is to be remembered, that though, even when
it is properly taught and enforced, it may occasionally act as the
exciting cause of insanity, its general influence tends to remove
the predisposing causes to which I have alluded, and its universal
prevalence would be attended by their entire removal. It is also to
be remembered, that of all those cases which are charged to religion
by an indiscriminating public, and by the enemies of Christianity, in
very few of them is the insanity produced by the proper presentation
of religious truth, while in the great majority of them it owes its
origin to the wild vagaries and the rash measures of the errorist,
the ultraist, and the fanatic.
A fruitful source of insanity is to be found in a general debilitated
condition of the system, which may be induced by a great variety
of causes. Such a condition is commonly characterized by a morbid
nervous irritability, which, with the aid of concurring causes, often
produces mental derangement. A very large proportion of the inmates
of our Insane Retreats present this condition of system. Their
physical and mental energies have both been exhausted by incessant
toil, and care, and anxiety from year to year, and long continued
ill-health has at length resulted in insanity. I may remark that we
see, in the loss of physical vigor as a cause of insanity, the chief
reason why there are more females than males among the insane.
As intemperance combines so many of the agencies which tend to
produce insanity, it is justly considered as one of the most prolific
sources of this disease. Strong drink exerts its destructive
influence upon the whole man, mental, moral, and physical. It
dethrones the reason, and inflaming the passions, gives them the
supremacy. It creates a morbid excitement throughout the whole
nervous system, and especially in the brain, the great central organ
of this system, and the instrument of the mind. It affects other
organs also, and particularly the stomach, which sympathizes so
readily with the brain, that its disorders, as is known to every one,
have a great influence upon that organ. Strong drink, therefore,
acting in these different ways upon the system, not only expends the
vital power rapidly, bringing on premature old age, but it makes its
deposites of disease here and there in the various organs, which
seriously embarrass them in the performance of their functions. With
such an impaired and diseased state of the system, and with the
constant excitement to which both body and mind are subjected, it is
no wonder that the intemperate are peculiarly liable to insanity.
In looking at the causes of insanity we readily discover the reason
why children are so seldom insane, though, from the liveliness of
their sympathies, they are much more apt to be _temporarily_ deranged
by disease than adults are, as we see in the paroxysms of fever. The
brain and nervous system require a long series of influences to bring
them into such a state, as renders them liable to that class of
diseases, which we include under the name of insanity. This state is
an accumulated result of the action of predisposing causes, continued
for some length of time, perhaps during all the previous life of the
patient. But the derangement of the child ceases with the temporary
disease which causes it. Its organs, not being incumbered with any
accumulations of disease, return readily to the performance of their
healthy functions; and its nervous system not having been shattered
with repeated attacks of sickness, and not having experienced the
wear and tear of trouble and toil, resumes at once its usual free and
easy and buoyant condition.
But, though insanity is not a common disease in the early years of
life, the foundations are often laid for it in this forming period.
The intellectual is often cultivated at the expense of the physical,
thus inducing that debilitated, and at the same time irritable
state of system, which you have seen is one of the prominent causes
of insanity. The passions, instead of being curbed by reasonable
restraints, are left to run riot. False views of life are permitted,
with all the bewitching fascinations which genius and fancy and wit
can furnish, to stamp their impress upon the mind, and through it
upon the brain during the impressible period of its growth. Luxury
too pampers the appetites, and gives to them a supremacy, which
debases and impairs alike the physical and the mental powers. When
the child therefore becomes the man, it is not strange that the
predisposition, thus formed within him by this moral and physical
training, should become more and more developed amid the stirring and
troublous scenes of active life, till at length, through the agency
of some exciting cause, insanity appears as the accumulated result
of all these evil influences. Education then, using the word in its
widest sense, has much to do with the production of insanity when it
is directed by wrong principles; and, on the other hand, it can be
made under proper management, to exert a powerful influence in the
prevention of this disease.
Let me now call the attention of the reader to a few considerations
in regard to the forms and the signs of insanity.
In some cases the symptoms of this disease are from the first of so
marked a character that no one can mistake the nature of the malady.
But in other cases its signs are for a long time indistinct, and no
period can be accurately fixed upon as marking the commencement of
the disease. Such cases are apt to be very obstinate, and the longer
they continue without proper treatment, the more difficult is it
to effect a cure. And delay is so common on the part of friends in
relation to such cases, that many of them, in which an early adoption
of the proper course would have resulted in an entire restoration
to health, become incurable before anything effectual is done. In
order that cases of this character should not be thus neglected, the
community need to be enlightened in regard to them.
The conversation and the conduct of such patients often exhibit no
signs of aberration of mind, which would strike the common observer,
even when the disease has existed for some length of time. And when
physicians assert that they are insane, some of their friends are
apt to doubt in regard to it, and sometimes they even controvert the
assertion. Of many cases of this character which have come under my
observation, I will allude to but two. One of them is the case of a
lady, whose insanity, which had taken the form of religious ultraism,
had been coming on very gradually for a long time. Though it was
of so deep a character as to be absolutely incurable, many even
very sensible persons among her acquaintances expressed their doubt
of the necessity of taking her to an Insane Hospital, and probably
would have cast blame upon me for so doing, had she not at one time
summoned her friends around her, and after giving some singular
directions and parting counsels, retired to her chamber and laid
herself down to die. Such palpable acts as this, are often the first
evidence that convinces the friends of a patient of the reality of
his insanity. Though it may have existed for weeks or months, they
perhaps have thought him to be nervous and ‘in a strange way,’ as it
is expressed, but they have not really supposed him to be insane.
The other case which I will mention is one which was brought to
the consideration of the civil authority of the town. I was called
upon to testify in relation to it. The proofs of this gentleman’s
insanity, which I adduced, were even made the subject of ridicule
by a portion of that wise body of men, and yet his insanity very
soon became so decided that he might be seen from day to day in our
streets picking up rags and strings and bits of wood and coal.
The delusions of some patients are confined to some particular
subjects. Upon these their insanity will appear in their
conversation, while upon all other subjects they are perfectly
rational. A man, who conversed with the utmost propriety on all
other topics, on being asked if he believed in Jesus Christ, said at
once, ‘I am Jesus Christ.’ A lady, who had very ambitious desires in
relation to her husband’s standing in society, became insane upon
this point alone, and while she was as rational as ever on all other
subjects, she constantly poured a storm of reproach and abuse upon
him, because he was not as great a man as she wished and expected
he would be. A lady, who had been much fatigued in preparing for
house-keeping, upon going into her new abode contracted a feeling in
regard to the house, which was something more than a mere dislike—it
was a horror. She could not bear to be in it, especially if she were
alone. She had an impression, ill-defined but unconquerable and ever
present, that something dreadful would happen to her if she remained
there. She said that she had rather live anywhere else, even in the
poorest shanty. Her friends thought that it was a foolish notion,
which she could overcome if she would make the effort. But they were
mistaken. She was really insane on that one point. I recommended that
she should be permitted to stay away from her house so long as she
desired it, and that her mind should be diverted by journeying and
visiting. A few weeks sufficed to remove the delusion. I once knew
a similar case in which the patient was not removed, and her misery
finally drove her to the commission of suicide.
It may be remarked of these cases of monomania, as it is termed,
that they do not ordinarily retain the same definite and exclusive
character which they at first have. If the insanity continue for some
length of time, other delusions are apt to be added to the original
one.
_Moral_ insanity is a form of the disease which is scarcely believed
to exist by the community at large, and our courts of justice are
very reluctant to recognise it, and will not do so without the most
indisputable and abundant evidence. And yet this form of insanity
is by no means rare. Many cases of it are found in our Retreats;
and the outrages, which such patients commit, are occasionally
made the subject of investigation before our legal tribunals. It
is an insanity of the moral sense, affecting the intellect little
if at all. Dr. Bell in speaking of it says, “There is insanity of
_conduct_, but not of _conversation_; the persons afflicted are
capable of reasoning with correctness and energy upon premises not
only false, but which they know to be false, and frequently display
the greatest ingenuity in giving reasons for and explaining away
their eccentric and unjustifiable conduct, and accounting for the
change which, they will admit, has occurred in the whole tone and
temper of their dispositions and propensities.
“It is a form of disease in which, perhaps more than in any other,
acts which, in a rational and responsible being would be crimes, are
committed. It occurs, at times, as the sequel of violent attacks of
mania,—it passes into decided mania or demency,—it alternates with
intellectual derangements; all which circumstances afford an adequate
presumption of its being a genuine form of insanity.”[40]
“Sometimes” says Professor Smith of New York, in a very excellent
description of this form of insanity, “it shows itself in the
abandonment of ordinary habits and pursuits; in carelessness of
one’s own affairs with random indulgence in follies and gross
sensualities. Sometimes it is seen in the form of ardent devotion
to a succession of projects, each suddenly conceived and embraced,
with, it is believed the certain prospect of rapidly amassing wealth,
or advancing in honor and happiness—and each as suddenly given up
in disgust. In some cases there is an uncontrollable disposition to
merriment, boisterous hilarity, and sportive and mischievous conduct
towards others. Occasionally the more striking phenomena are inflated
pride, exquisite vanity, and contempt of ordinary things. Frequently
it assumes the character of melancholy or deep gloom, attended with
fondness for solitude, and forebodings of evil when all around and
in prospect is inviting and joyous. A form not uncommon displays
itself in an unaccountable partiality for particular persons, and
a dislike of the nearest and dearest friends, with a disposition
to revile and injure them. The more serious varieties are those in
which there is a suicidal propensity, or a feeling of necessity
to commit some dreadful crime—for example, to destroy a certain
individual, perhaps a relative, as a tender and beloved child—an
act, the execution of which, the reasoning power strongly opposes,
and the conscience prevents by awakening the feeling of horror.
These restraining forces, however, are not always sufficient to curb
the strong propensity. Sometimes, as if urged irresistibly by some
demoniac influence, the fatal deed is perpetrated; and instant relief
from the burning passion is obtained; the homicide feels that a part
of his destiny is fulfilled, and hence an emotion of satisfaction
spreads over his mind. But such relief is not always durable; regret
and remorse may succeed, and rankle long and deep in the soul.”[41]
I will pass on now to a few remarks upon the _treatment_ of insanity.
The past history of the treatment of this disease is to a great
extent a history of tyranny and cruelty. The errors and abuses which
have generally marked the management of the insane, till within a few
years, are numerous and truly horrible. But these errors and abuses
are fast passing away. Ever since the wise and humane physician,
Pinel, entered in 1792 the Bedlam of France, in whose cells three
hundred maniacs were chained, and in the short space of a few days
knocked off the chains from fifty-three of them with none but happy
results, the management of the insane has been becoming steadily
more wise and merciful from year to year.[42] In producing this
change throughout the community, the public institutions for the
insane have had a great agency. I will therefore pass at once to the
consideration of the usefulness of these institutions, as the best
mode which I can adopt for developing the principles to be observed
in the treatment of insanity.
The advantages of Retreats, or Hospitals for the Insane, may be
summed up under three heads, which I will notice separately.
1. In sending a patient to a Retreat you take him away from all
those mental associations under which his insanity originated. These
associations are so many _points of attachment_, by which his malady
is fastened upon him; and it is therefore almost a _sine qua non_
in the cure to release him from their influence. The power of these
associations is most strikingly shown in the renewal of the insanity,
in those who are returned to their homes before their restoration
is fairly confirmed. Change of scene, as is known to every one, has
a good effect upon invalids generally; but it is especially true
of those invalids whose disease is insanity. Accordingly a very
important part of the treatment of the insane in a Retreat, consists
in such a management of their occupations and amusements, as will
best divert their minds from those channels of thought and feeling,
in which they have previously run.
2. The insane are ordinarily subjected to a more judicious _medical_
treatment in a Hospital than they are among their friends. It is
the testimony of all who have had charge of the insane, that their
restoration depends mostly upon regimen, or the regulation of their
occupations and amusements, bodily and mental, and very little
indeed upon medicine. It is undoubtedly true, that the deranged are
very often injured by too much positive medication prior to their
admission to a Retreat. They are first dosed by their friends, and
the physician who is called in, having had perhaps but a limited
experience in insanity, places too high an estimate on the curative
power of remedies in this malady, and gives the patient altogether
too much medicine. It was once very common to bleed the insane. But
it is now settled by the accumulated experience of the profession,
that very few of them require this measure, and that most of them
would certainly be injured by a reducing practice.
3. In sending a patient to a Retreat, you place him under a better
moral and mental management than he can have among his friends.
There is a peculiar tact requisite for the proper management of the
insane, which some seem to possess naturally, and which is much
improved by actual practice. In the selection of attendants in our
Retreats special regard is of course had to the possession of this
qualification. The attendants are therefore skilful in managing the
insane mind. They are free from those errors which are so common in
the community in relation to the treatment of insanity, and which
often do so much harm to the insane while they continue under the
care of their friends at their homes. Some of these errors it will be
profitable to notice briefly in this connection.
It is very common for the friends of the insane to attempt to
_reason_ them out of their delusions. If the derangement be of a
religious type, the clergyman, or some excellent friend, endeavors
by argument to convince the patient of his error. This is in vain,
and worse than in vain. _It uniformly does harm._ It does nothing but
strengthen the patient’s confidence in his notions, and make him more
earnest and obstinate in their defence.
It is quite common still, though not so much so as it once was, to
practice deception upon the insane. This ruinous error I comment upon
in the chapter on _Veracity in our Intercourse with the Sick_, to
which I refer the reader.
Another error which is frequently committed, is to pursue a timid
course at one time and a violent one at another, instead of one which
is both mild and firm throughout. This error has been the cause of
the practice of much unnecessary cruelty in the domestic treatment of
the insane.
These and other errors are for the most part avoided by the
attendants in our Hospitals. They have no needless collisions
with the patients in regard to their notions and delusions. They
practice no deception upon them, but win their confidence by an open
and candid intercourse. Their conduct towards them is marked with
mildness, and they make use of no more restraint than is absolutely
necessary, and that with calm firmness, instead of impetuous and
noisy violence.
It is a common observation that the deranged are apt to look upon
their most intimate friends as their enemies; while, on the other
hand, they are ordinarily much attached to their attendants and
physicians. The reasons of this I will briefly notice. In every
family, however warm may be its attachments, and however strong may
be the control of principle in its members, there must be differences
of taste and feeling and opinion, and a mutual yielding on these
points is absolutely essential to the maintenance of harmony and
peace. Now if one of the members of that family become deranged,
his self-restraint is gone, and he no longer does his part of the
yielding. He becomes unreasonable, obstinate, opinionative. There is
no more agreeing to differ on his part. All the points of difference
between him and his friends become now to him so many battle
grounds; and those whom he fights he is apt to hate. The injudicious
discussions and disputes, which friends are disposed to hold with
the insane, add to the difficulty. Then too the deceptions, which
most persons feel themselves authorized to practice in such cases are
certain to confirm the enmity, by destroying the confidence of the
insane in their candor and honesty. I need not stop to show, that
there is an absence of all these circumstances in the intercourse
between the insane and their attendants in a Retreat.
The reader cannot have failed to see in the course of my remarks,
that it is very important that the insane should early come under
proper treatment. The first indications of insanity should be
noticed, and measures should at once be taken to convey the patient
to some Retreat. The delay which is so apt to occur in relation to
those, in whom the malady comes on slowly and imperceptibly, is one
great reason why so many of them are incurable. If these could all in
the very beginning be removed away from the influences, which have
produced and are maturing their insanity and be placed under proper
treatment, many more of them would undoubtedly recover than now do.
Among the most helpless and pitiable of the miserable in this world
are the insane poor. Ordinary sickness requires only ordinary care.
But insanity is a malady, which not only often requires more care
than other sickness, but a care which is, as you have seen, of a
peculiar character—such as the comfortless home, the want, and the
ignorance of the poor are unfit to supply. It is the duty of society
therefore to make systematic and ample provision for the proper care
of this class of the insane. In many of the states some provision
has been made for them, but it is very inadequate. The provision
in Connecticut is an annual appropriation placed in the hands of
the Governor to be dispensed by him to applicants till the whole
sum is expended. In this way a large number of the insane poor have
secured to them a residence for a suitable period in the Retreat at
Hartford. This is well so far as it goes, but it is not sufficient.
_All_ the insane poor in the State should be provided for. And
the expense need not be very great if a proper plan be adopted. A
portion of the expense, one third or one half, should be defrayed
in each case by the town where the patient resides. In this way any
improper use of the public benefaction would be guarded against,
for the local authorities would, in behalf of the towns, secure a
suitable examination of the pecuniary circumstances of the patients.
Such a plan would be a truly economical one. For many, who, with the
scanty and irregular provision which is now made, are left to become
hopelessly insane, and to be therefore lasting burdens to the towns
in which they reside, would under a better plan be restored and
become able to support themselves.
This chapter is already so long, that I must devote less space than
I originally intended to the _legal relations_ of insanity. A few
points only can be briefly noticed.
The legal relations of insanity are very imperfectly understood, even
by those who are concerned in the administration of justice. The
lawyer at the bar, and the judge on the bench, often exhibit great
ignorance on this subject. The history of the legal definitions of
insanity, given by learned judges, is almost from beginning to end
a history of profound blunders. And yet these definitions have been
the guide in trials in which insanity has been alleged, except when
they have been set aside by the plain common sense of the jury, as
has sometimes very fortunately been the case. In speaking of the
inconsistencies and absurdities of the English law in relation to
insanity, Dr. Bell, in his valuable report to which I have before
had occasion to refer, remarks, that “from the test of Judge Tracey,
that to exempt from criminal responsibility, the patient should
know absolutely nothing, to that of a later tribunal, where ability
to repeat the multiplication table was gravely considered as the
exact point in a civil case, the doctrines and decisions have
been amusingly strange and inconsistent. Even cunning, foresight,
calculation, all possessed occasionally in a wonderful degree by the
most insane patients of every hospital, have been regularly decided
by the highest English tribunals, to contraindicate the existence of
that degree of alienation which implies criminal irresponsibility!”
The course which is adopted by our courts, to decide whether a man
accused of any crime is insane and therefore irresponsible, is a very
objectionable one. In France they are far in advance of us on this
subject. The course there is to place the accused, if suspected of
insanity, under the examination of a commission composed of men who
are practically qualified to decide such a question. “Upon them,”
says Dr. Bell, “rests the awful responsibility of determining the
state of the mind of the accused, as to the one fact of insanity;
they approach him at all times, they watch his actions in his
presence and without his knowledge; his habits, his sleeping and
waking hours, his physical condition, everything in fact which
can throw light upon the momentous question, passes under slow,
persevering, scientific investigation. Under the responsibility
of reputations as precious to them as those of the highest court,
and under the sanction of an oath, they arrive at conclusions, and
present their reasons for such conclusions, which form one, not the
exclusive, element for a court and jury to arrive at a just judgment.
How are the facts, elucidating the state of a prisoner’s mind after a
doubtful act, ascertained with us? The functions devolved in France
upon the bright professional luminaries such as I have named, here
fall upon the gaoler, the constables, and the turnkeys. _Experts_
may on the day of final trial be summoned in, to give their opinions
on testimony, derived from such sources as this! No provision exists
for any investigation beyond the _volunteer_ aid, which such an
ungracious task will rarely secure. The moment for investigating
the perhaps fleeting manifestations and evidences of disease
passes, before the law makes the least advances for the prisoner’s
protection. I have even known the instance of a professional man
whose life was spent among the insane, and who, moved solely by
humane feeling, had visited in prison a friendless wretch whose
homicidal act was feared from circumstances to be the result of
insanity, being held up and vilified to a jury by a government
functionary, for his _officious_ intermeddling in matters in which he
had no concern!”
Such having been the opinions and practices of our courts of justice,
it is not strange that the rights of the insane have often been
trampled upon and that _even life has been sometimes sacrificed
under all the solemn formalities of law, for acts committed in the
irresponsible condition of insanity_. I could cite _many_ sad cases
in illustration, but I will merely advert to one of a recent date,
which the efforts of one individual prevented from being added to the
long list of cases, in which the robe of justice has been stained
by the blood of irresponsible maniacs. I refer to the trial of the
poor negro Freeman, who killed the Van Nest family, consisting of
four persons. In this case a verdict of guilty was given, and the
community who came near resorting to Lynch law before the trial,
were eager to have the sentence executed. Governor Seward, who, to
his praise be it spoken, as a volunteer nobly stemmed the raging
torrent of popular excitement, defended the prisoner. He succeeded in
obtaining a grant for a new trial. This trial never took place. The
judge, before whom he was to be tried, visited the prisoner in his
cell, and becoming satisfied of his insanity, refused to try him. In
a few short months the prisoner died, leaving no doubt upon the mind
of any one acquainted with the case that he was truly insane.
It is true that the plea of insanity, just like any other plea, is
often set up when there is very little ground for it. But there
is good reason to believe, that it is very seldom established and
made the basis of an acquittal, when it ought not to be. Dr. Bell
remarked upon this point in 1844, that “it may be a consolation and
an encouragement to juries, in faithfully following out their own
sincere convictions upon the law and evidence in such cases, to
know, that in a pretty diligent inquiry as to the event of every
case of homicide in New England, where the accused has had the
defence of insanity ‘set up’ for him, and been acquitted on that
ground, it has been found that _not a single instance has occurred,
where the progress of time has not abundantly verified the soundness
of the defence_.” And he has recently informed me that this assertion
holds true up to the present time.
While it is important that justice should be secured to the insane,
when placed under trial for acts which they have committed, it is
of still greater importance that such acts should, if possible, be
prevented. If, when a man in an irresponsible condition destroys the
life of a fellow-man, we prevent his innocent blood from being shed,
we do well: but if we recognise the existence of that condition, and
the danger to others which attends it, sufficiently early, to take
measures to prevent his destroying the life of his fellow-man, _we do
better_.
This point of prevention should be made an especial object of
legislation. But in this country the laws which aim at this object
are exceedingly defective. In Connecticut it is the duty of the civil
authority and select men to order “any lunatic, who is dangerous
and unfit to be without restraint to be confined in some suitable
place.” If they fail to attend to the complaint, in three days it
may be brought before any justice of the peace, and he can issue
such an order. In Massachusetts the judges of Probate may commit to
the hospital any lunatic “who in their opinion is so furiously mad,
as to render it manifestly dangerous to the peace and safety of the
community, that he should be at large.” The objectionable points in
these provisions are two. 1. Those are made the judges of the fact of
insanity, and of the danger to the peace and safety of the community
attendant upon it, who are not competent to pass such judgment. When
we say that judges of probate, selectmen, and justices of the peace
are not thus competent, we say nothing to their discredit. Insanity
is a subject which they have no opportunity of understanding with any
definiteness or to any extent. 2. The terms in which these provisions
are couched show, that only great and manifest danger is contemplated
by them. Some outrage or attempt at outrage is commonly therefore
to be proved, in order to authorize in the view of the law the
confinement of the person complained of.
With such defects in the provisions of the law, it is no wonder that
the community is occasionally shocked with outrageous, even fatal
acts by insane persons, who through neglect have been permitted to
go at large. Indeed, in some cases there has been no apprehension
of danger up to the time of the commission of such acts; and yet if
these cases had been submitted to the examination of those who have
knowledge and skill on the subject of insanity, the danger would,
generally, at least, have been foreseen, and the acts would therefore
have been prevented. To secure such an examination a standing
commission of lunacy should be appointed, composed of physicians
who are properly qualified to decide the important questions which
would come before them. Every case of suspected insanity should
be subjected to their examination, and it should be their duty to
prescribe what measures shall be adopted in regard to each case.
Such a commission would not only prevent the peace and safety of the
community in many cases from being violated, and save many valuable
lives, but it would also secure a recovery in many cases of insanity
in which now neglect renders such a result impossible.
Many other points in regard to the legal relations of insanity might
be noticed with profit and interest to the general reader, but this
chapter is already sufficiently long. In conclusion I cannot but
express the hope that our lawyers and judges will give more attention
to this part of medical jurisprudence; and that the abuses which
exist may be speedily removed, so that the pretender to insanity may
be sure to be detected and punished, and the truly insane may as
surely be secured in their rights.
FOOTNOTES:
[40] Annual Report of the McLean Asylum, 1843.
[41] A Discourse on the Influence of Diseases on the Intellectual and
Moral Powers, by Joseph M. Smith, M. D., Professor of the Theory and
Practice of Physic, and Clinical Medicine.
[42] The following very interesting account of this experiment is
taken from an article on the treatment of lunatics, in the London
Quarterly.
It was during the reign of terror, and while all France labored under
a new form of insanity, that the idea was first conceived of setting
loose madmen from their bonds. The good and wise physician, Pinel,
seems to have been struck with the injustice of keeping the patients
chained in the dungeons of Bicetre, while so many hundreds of his
countrymen, more mischievously distracted than many of them, were at
large to work the bloody frolics of the revolutionary frenzy. There
were at that time upwards of 300 maniacs chained in the loathsome
cells of the horrible Bedlam of France. Pinel formed the resolution
of setting them free from their strict restraint, and he entreated
permission of the Commune to that effect. Struck with the novelty
of the enterprise, at that time a sufficient recommendation before
any assembly in France, the Commune listened to the proposal, and
deputed one of their body, the notorious Couthon, to accompany the
physician to the spot, and judge of the propriety of carrying his
undertaking into effect. They were received by a confused noise—the
yells and vociferations of some hundreds of madmen, mixed with
the sounds of their clanking chains, echoing through the damp and
dreary vaults of the prison. Couthon turned away with horror, but he
permitted Pinel to pursue his enterprise. The philanthropist resolved
speedily to liberate fifty of the number by way of experiment, and
began by unchaining twelve of the most violent. The account of his
proceeding has been recorded by his nephew, Sclyion Pinel, in a
lively narrative, which was read before the Academy of Sciences. The
first man set at liberty was an English captain. He had been forty
years in chains, and his history was forgotten by himself and all
the world. His keepers approached him with dread; he had killed one
of their comrades by a blow with his manacles. Pinel entered his
cell unattended, and accosted him in a kind and confiding manner,
and told him that it was designed to give him the liberty of walking
abroad, on condition that he would put on a waistcoat that might
confine his arms. The madman appeared to disbelieve; but he obeyed.
His chains were removed, and the door of the cell was left open.
Many times he raised himself and fell back; his limbs gave way; they
had been ironed forty years. At length he was able to stand and to
stalk to the door of his dark cell, and to gaze, with exclamations
of wonder and delight, at the beautiful sky. He spent the day in
the enjoyment of his newly-acquired privilege; he was no more in
bonds; and during the two years of his farther detention at Bicetre,
assisted in managing the house. The next man liberated was a soldier,
a private in the French guards, who had been ten years in chains,
and was an object of general fear. His case had been one of acute
mania, occasioned by intemperance—a disorder which often subsides in
a short time under abstinence from intoxicating drinks unless kept
up, as in this case, by improper treatment. When set at liberty, this
man willingly assisted Pinel in breaking the chains of his fellow
prisoners; he became immediately calm, and even kind and attentive,
and was ever afterwards the devoted friend of his deliverer. In an
adjoining cell there were three Prussian soldiers, who had been many
years in chains and darkness; through grief and despair they had sunk
into a state of stupor and fatuity, the frequent result of similar
treatment; they refused to be removed. Near to them was an old
priest, harmless and patient, who fancied himself to be the Savior of
the world. When taunted by the keepers, who used to tell him that, if
he was Christ, he could break the heavy chains that loaded his hands,
he replied with solemn dignity, _Frustra tentaris Dominum tuum_.
After his release he got rid of his illusion, and recovered the
soundness of his mind. Within a few days Pinel liberated fifty-three
maniacs from their imprisonment. The result was beyond his hopes.
Tranquility and harmony succeeded to tumult and disorder, and even
the most ferocious madmen became more tractable. This took place
in 1792; and the example of Pinel was followed in various parts of
France.