INSOMNIA——INSANITY.
Sleeplessness is often referred to as a cause of insanity, but it would be
much nearer the truth to say that insanity causes sleeplessness. Dr. Rush
says: “A dream is a transient paroxysm of delirium, and delirium a
perpetual dream.” Not every dreamer becomes insane, in the common
understanding of the term, nor every person who is distressed by
wakefulness; nor do all those persons who dream dreams of a strange,
droll, startling, heart-rending, exhausting character, become inmates of
lunatic asylums, although all such are fit subjects for a rigid hygiene;
and not a few out of this large number of bad dreamers——who are likewise
afflicted with insomnia——but could with advantage place themselves under
the charge of an expert in diseases of the brain, or even in an asylum, if
either the former, or the physicians in charge of the latter, were in all
regards thoroughly equipped for their work——a rare circumstance indeed.
Normal sleep is dreamless; in default of this total oblivion, sleep is
only partial——it is not perfect nervous repose. No person who suffers
severely from indigestion but is also troubled with much dreaming, and,
more or less, with wakefulness; and no person who has these last-named
symptoms but can safely set them down; at least in great measure, to
digestive disorder; and as, almost invariably, removable by improved
habits.
Some very wise men have stated as their belief, that no man living is
really of sound mind, any more than of sound body, in the strictest
application of the term; all have their crazy aspects——their “weak spots,”
as we say; and the anxious, brooding man, who fears the loss of his
reason, may take courage from the thought that his symptoms are only a
little worse than his neighbor’s, and only demand of him to diminish his
dyspepsia if he would become normally insane! To attack insomnia as a
disease instead of a symptom, is sure to result in discomfiture in the
great majority of cases, and is in every instance unsound in principle.
Once established, this condition of wakefulness tends to perpetuate
itself; but this would be otherwise with an absolutely natural regimen. A
man is wakeful at night because under his present physical condition he
ought to be——just as in diarrhœa, the looseness is doing its work of cure.
So with all symptoms. _Pain_ has its office, and this is coming to be
better understood; is already well known to thoughtful, well-informed
people; and the _wakefulness_ of which so many complain, and which, in
some cases, is of the most distressing, painful character, is as truly
normal, considering the present physical state of the sufferer’s brain, as
is pain following a cut. As an aid in the removal of this symptom, next to
a radical reform in one’s living habits, which is the only possible cure
for the disease, the above reasoning is one of the most effectual.
When a man is wounded severely his anxiety is not increased by the pain;
it causes no additional alarm, because he knows that it is entirely
natural; let him know that sleeplessness is an analogue of pain, and he
will, or may, bear it philosophically, and thus tend to its removal. He
has a poverty-stricken mind, indeed, who can not, under such
circumstances, pass an hour, or several of them, in comparative comfort,
knowing that sleep will come in good time. But, thinking all the while
that it is sleep only that he needs, his sleeplessness distresses him,
causes him to be more and more alarmed, and, consequently, has the effect
to postpone the oblivion so devoutly prayed for, but so little earned. To
_deserve_ sleep is to _have_ it. Let the insomniac read the concluding
article of this volume, and by the light of it review the hints on diet,
air, exercise, etc., in the body of the article on consumption, so as to
know what he has to do to become a _good man_, physiologically; and go to
bed at about the same hour every night, if possible, or at any rate when
he does lie down to sleep it should be after a quiet hour or half-hour
devoted to peaceful and thought-steadying occupations, never exciting
mental exercise, whether amusing or instructive; and when he draws the
blankets about him, let it be with a sublime indifference as to whether he
shall or shall not go to sleep promptly. “As to the subduing of the
senses, the attempt to shut out external impressions by deafening the
ears, closing the eyes, and lowering the sensibilities generally, is in
itself a frequently recognizable and always possible cause of persistent
wakefulness. The effort to compose the mind (after lying down) and subdue
the activity of the senses is made by the higher mental faculty, a part or
function of the organism which, of all others, needs to be itself restful
in order that the physico-mental being may sleep. It is, therefore,
obvious that an _endeavor_ to go to sleep is a mistake.”[50]
[Footnote 50: J. Mortimore Granville, M.D., in _Good Words_.]
Rather let me, when staring out into the darkness,——for to attempt to shut
out the sense of sight by closing the eyes is always to render the
inner-mental sense increasingly acute: “the field of sight is soon crowded
with grotesque and rapidly changing images——a phantasmagoria, the worrying
effect of which is only a too familiar experience of the sleep waiter,”
and all the mental senses are in like manner stimulated, and their
acuteness intensified, by the endeavor to lower the sensibility of the
sense organs; and, worst of all, to narcotize them with drugs or
sleeping-draughts is irrational and its effects injurious, and if long
continued, fatal;——rather, I repeat, having ears to hear, let me hear, and
eyes to see, see; and a brain, let me think. Let the brain, the ears, and
the eyes “forget their cunning,” only when the eyelids droop in sleep
because I am sleepy. Meantime, not self-abasingly, but calmly and
dispassionately, would I philosophize thus: Well, I am in for it again! I
would like to sleep promptly, soundly, and long; why do I not? I suspect
that I am not running this physico-mental machine even in a fairly
physiological manner; I cause it to run at an abnormal rate during the
day, and keep up intense mental excitement through stimulation of one sort
or another, prolonging excessive mental activity too far on toward the
night; and because of this, and the lack of a fair degree of muscular
exercise, I only half breathe; of my fifteen or sixteen inspirations per
minute, not one distends the air cells of my lungs to half their capacity.
[Thus it transpires that the organism suffers in two ways, viz.: (1) the
circulation is not sufficiently oxygenated for its general purposes; and
(2) the waste matters are not “_pumped out_” of the substance of the
brain,[51] as effectually as need be]. My coffee was strong and nice this
morning; it stimulated me very satisfactorily throughout the day; and,
what I had not bargained for, I am still feeling the spur (see article on
Coffee). That new brand of cigars is exquisitely flavored; but, upon the
whole, a perfect night’s sleep would be far more exquisite; at least, just
now I am in the mood to think so. I sneered at that food-reformer who told
me he was never a good sleeper until his present simple, natural habits
made him so; but now, just at this moment, it seems as if it would be a
good trade to exchange some of my favorite dishes for coarse food and
balmy sleep! Oh, if I only could get “balmy” that way every night! I “got
the best” of ———— yesterday morning on those ———— stocks, and spent an
hour, bent over my desk, figuring to see how I could get hold of some more
at that price, before its holders had time to ascertain its real value. I
will tell the widow ———— in the morning, what it is worth, instead of
trying to buy hers under-price as I contemplated doing. And so I would con
over and look through myself and my habits, feeling sure that my eyelids
would droop, and sleep would come before I should have completed the work
of reform; and I am sure that every sufferer will find that a real
reform——a permanent reform——will unfailingly lead on to _health_, and so
to sweet and satisfactory sleep.
[Footnote 51: “As stimulation of the brain causes dilatation of its
vessels, and increases the flow of blood through them, mental action of
itself not only attracts more blood to the brain, but provides to some
extent for the removal of waste products. Hence sleeplessness is normal
for a clogged brain. The movements induced by the cardiac pulsations are
not so extensive as those caused by the respiratory movements or by
muscular exertion, and therefore, when the brain is overworked and the
respiratory and muscular movements are restricted, the cerebral nutrition
will be diminished by the imperfect removal of waste from its substance.
But if, in addition to this, the cerebral cells and fibers are actually
poisoned by the circulation within the vessels which supply them, of
noxious substances due to imperfect digestion or assimilation, matters
will become very much worse.”——T. L. BRUNTON, M.D., F.R.S. (ibid.)]
“Let no sleepless person be discouraged. Maintain hope under all
circumstances. Remember that there are many worse cases of suffering than
your own in the world, although to you it seems impossible. Keep up your
general health by all sanitary means possible; walk much in the open air,
if you can walk; ride, if you can not walk. Above all measures, keep the
functions of the skin in prime condition; cleanliness is antagonistic to
sleeplessness. Dry friction over the body by the use of the hand, or
better by the use of the French hair mitten, twice a day, we have found of
great service. The air-bath should not be neglected. A few minutes after
the employment of friction over the body, walk about without clothing in a
cool room, and if possible let the sun strike upon the body. Do not
remain uncovered too long, so as to become chilled. Keep the digestion
good; eat only such forms of food as suit the digestive organs. Surround
yourself with cheerful company if possible, read such books as do not tax
or weary the mind, and life will cease to be a burden, even if you do not
sleep as others do. Avoid above all things constant dosing; throw into the
ditch, or into the sea, all nostrums that may fall into your hand.”
Comparatively few, even of the so-called hopelessly insane, but might in
the early stages of their disease be completely restored; and at any
period, so long as there is great vital force, or what would commonly pass
for robust physical health, no case need be set down as hopeless. But
while the present system of treatment prevails (it is not worthy the
appellation of “system,”) the present small proportion of “cures” will
continue to be the rule. The inmates are confined more or less closely,
often in imperfectly ventilated apartments, deprived of the exercise in
the open air they so much need, to the lack of which in their own homes
is, in part, attributable their present condition; they are fed
generously, even to plethora; and this, through the fault of the ignorance
of their attending physicians, although, if these were wise enough to know
when and how their patients needed “dieting,” the friends of these
sufferers would never submit to anything bordering upon a strictly
abstemious diet in their treatment. In visiting lunatic asylums in this
and other countries, I have been struck with the appearance of groups of
patients——the similarity of their _physique_, as compared with the men and
women seen on our streets every day——fat or lean, seldom medium——all
exhibiting clearly the physical characteristics of disease, as emaciation,
obesity, lack of, or ravenous, appetite, usually the latter. Meal-time
comes every five or six hours, and if the appetite is good, all are
permitted to eat very much in excess of their needs; they are urged to eat
when they desire to fast; and food is forced into their stomachs if they
are inclined to abstain for any length of time. It is not uncommon to find
patients who upon entering an asylum begin to fatten, though already in an
abnormal condition in this regard, their symptoms becoming more and more
discouraging as their weight increases, although neither physician nor
friends connect the two facts in any way. The latter feel thankful that
“poor dear J———— gets enough to eat!” In this connection I introduce an
incident of recent occurrence, not as indicating that a compulsory fast
for an extended period should be resorted to generally, nor my own belief
that it is a specific for all mind-troubles, by any means, but as a fact
of great significance which all interested in this question may well pause
a moment to contemplate.
[Dispatch from Philadelphia to the New York _Herald_].
TANNER’S RECORD BEATEN.
AN INSANE ASYLUM PATIENT ABSTAINS FROM FOOD
FOR FORTY-ONE DAYS.
One of the most extraordinary cases of an insane man attempting to restore
his reason by voluntary starvation was discovered recently at the ————
County Insane Asylum. The case presents an interesting study for medical
men generally. ————, aged forty years, a well-known resident of ————, who
has been confined in the institution for the last two years, has abstained
absolutely from all food except water, for the space of forty-one days.
From the forty-second day of his fast until the fifty-first day he drank
one pint of milk daily, and from then began eating strawberries and milk.
This diet was maintained for three weeks, and was then succeeded by
oatmeal gruel and milk. The case is a matter of careful record at the
institution and under circumstances that prevented deception. Therefore,
there is not the slightest doubt as to the extraordinary performance
having been genuine. Mr. ————, when he first came to the asylum, was very
violent at times, but, like many insane persons, he was a ravenous eater.
His insanity is supposed to be hereditary. Occasionally he has had lucid
intervals, and during these brief periods he frequently expressed the
belief that there existed some method by which the insane might have their
affliction alleviated if not entirely done away with. To Mrs. ————, the
matron of the asylum, he took a great fancy, and, while averse to having
anything to do with any other of the officials, he confided in her
thoroughly and often expressed the wish that his mind might be restored to
him and that he could be released. “For forty-one days,” said Mrs. ————,
“nothing passed his lips but water, and tepid water at that. Of this fact
I am thoroughly positive, knowing as I do the continuous efforts made
every day to induce him to eat. When he began the fast he had been living
on the same diet as the rest of the patients. He came to me and said,
seemingly in a perfectly rational manner, that he was anxious to be cured,
and that he thought abstinence from food for a time might benefit him. Mr.
———— said he did not intend to carry his experiment to extremes, but that
the moment he felt it would be proper for him to break the fast he would
do so. On the second day ———— again refused to eat, and did not go out of
his room. On the third day he drank a small cupful of water. At the end of
the seventh day he had drank about six pints of water, and the natural
functions of the body had then ceased. All of the attendants were
instructed to use every possible means to induce the man to partake of
nourishment, and a man was with him constantly through the day.”
“Could he not have obtained food at night?” was asked.
“It would have been impossible,” replied Mrs. ————. “All the rooms are
locked, and none of the patients have access to other parts of the
building after sundown. We would have been only too glad had he taken
food. About the 20th day he began to get thin and haggard-looking about
the face, and seemed to be feeble. He said that his head felt better, and
that he did not intend to eat anything as long as he felt so well. On the
35th day he became so weak that he had to go to bed, and remained there
until he broke the fast. I had told him that whenever he wanted to eat to
send me word, no matter what hour of the night or day it happened to be,
and I would see that he was provided with anything he might fancy. On the
afternoon of the 41st day since Mr. ———— had ceased eating,” continued
Mrs. ————, “he sent up word by an attendant that he should like to have a
cup of coffee.[52] I hastened to comply with the request at once, and had
a cup of very strong Java prepared. Mr. ———— drank it, and followed it up
an hour later with a cup of nice, rich milk. He stuck to the milk for a
week, I think, and then added strawberries. This low diet was kept up, oh,
for a long time, probably a month, then he gradually began eating oatmeal
mush and gruel, which has been maintained up to to-day.”
[Footnote 52: One of the worst moves be could have made; but it is
significant that this was his last attempt to return to his coffee habit.
In his renewed state it proved no longer enticing!]
“And you are perfectly positive, Mrs. ————, that Mr. ———— fasted
absolutely, with the exception of water, for forty-one days?”
“Perfectly satisfied,” replied Mrs. ————; “in fact, I know it. There can
be no possible doubt, inasmuch as the attendants were only too anxious to
force the man to eat.”
“Do you think the fast has made any change in Mr. ————’s condition?”
“Well,” replied Mrs. ————, “he will probably be discharged as cured at the
next meeting of the board of freeholders in August.”[53]
[Footnote 53: It is a matter of regret to me that this book goes to press
before I can ascertain the final result. Judging from the above account,
however, I should expect a thoroughly successful ending, unless it should
transpire that, true to their instincts, the attendants prevailed upon the
patient to abandon the simple regimen, which he adopted after the fast,
and resume the ordinary stimulating diet; in which case I should
confidently expect a complete relapse.
As a hint regarding the effect of a stimulating and excessive diet upon
persons of unsound mind, I subjoin a brief note taken during the trial of
the most celebrated lunatic of modern times: “Guiteau’s appetite is quite
as remarkable as his insolence. He has breakfast served in his room at the
court-house about nine o’clock, and usually consumes at this meal a pound
of steak, nine buckwheat cakes, three roasted potatoes, and five cups of
coffee. Then, at half-past twelve, he gorges himself on roast beef and
mutton.”]
A certain class of wakeful patients are benefited by the practice of
eating shortly before bedtime, when this right has been earned by
sufficient restriction during the day. To make this the fourth, or even
the third meal, however, is almost certain to increase the difficulty at
last. The victim of sleepless nights often finds himself quite overcome
with drowsiness after his midday meal. If then he could throw himself upon
the bed he would have no time to “count,” or even think of such a device
for putting himself to sleep. He was wide awake before lunch, and but for
the habit of taking it, could have finished the day better without than
with this out-of-season sleeping potion. Let him take the hint, eat his
second and last meal, a sufficient one of plain food, in the evening after
fully rested, and, thus equipped, go to bed directly, or after an hour or
two of agreeable, but non-taxing, social converse. He must avoid every
form of artificial stimulation——tea, coffee, wine, beer, tobacco. To
breathe the atmosphere of an office, hotel, or smoking-car, for any
considerable period, is no better, may be worse, than a moderate
indulgence at first-hand in the open air.