THE INSANE DIATHESIS.
The ideal human system would be one of perfection, that is, it would be
one so constituted as to discharge all its functions perfectly. Yet, its
capacities would be limited as they now are, though not to the same
extent. Digestion of such articles of food as the system requires would be
perfect, though this might not be true as to many other articles, which
are appropriate as food for other animals. Sight and hearing would be
perfect, but only within certain ranges and distances; memory would be
perfect in reference to every thing comprehended and understood. The
limitations would be dependent on the inherent nature of the organism, in
its relation to the external world. What is stated above as true, in
relation to certain parts of the system, would be equally true of the
functions of all parts of the human system, both physical and psychical.
Now, the _actual_ human system approaches toward this _ideal_ one in a
greater or less degree. It possesses all the faculties, both physical and
psychical, but they are tainted with imperfections, and their health
varies from the highest state attainable, down to some assumed standard,
below which we say that a diseased condition exists. It will, however, be
observed, and hereafter more definitely appear, that this border-line is
merely one of assumption. No definite standard can be applied to all
persons, and a condition which would be normal for one person may not be
so for another. Besides, the _actual_ condition of many persons is one of
changing stability, both in respect of the body and the mind, and this may
depend upon causes which operate from either _within_ or _without_.
A few simple statements in reference to differences existing among
persons, as to those physical and mental conditions which are inherited,
may be in point, and prepare the way for other considerations.
I. Though we may not be able to determine the causes of these differences,
yet it is quite evident that there exists, from the time of birth, the
largest diversity in reference to the physical constitution of persons:
while some are strong and vigorous, and capable of large effort, and of
enduring exposure to the heat and cold with almost indifference, others
are so delicate and sensitive as to be easily affected by such influences;
while the muscles of some are susceptible of making the most delicate and
difficult movements in all mechanical operations, with very little
training or education, those of others can never be trained sufficiently
to be able to accomplish them; the skin and the lungs of some persons are
so constituted as to be easily influenced by such degrees of moisture and
cold as have little or no such effect on those of others; the capacity for
labor, and endurance, also varies very largely.
Again, these physical conditions are more or less variable with many
persons. They are conscious of feeling more active and vigorous, of
experiencing a larger degree of pleasure in physical activity at one time
than at another; they may be conscious of more or less painful sensations,
experience a measure of indisposition to make effort; they may be more
restless and uneasy, and feel discomfort from slight causes which had
rarely before produced such results.
In short, there may exist not only a difference in the constitution of the
different organs of the body, but these natural conditions are more or
less changeful in their states, within certain limits, while still in a
state of health. There may exist a condition of over-activity, or of
under-activity, in any or all portions of the body, and from the operation
of causes, the nature of which we are entirely ignorant, and concerning
which persons do not much care, so long as they do not experience so much
discomfort as to be unfitted for their usual occupations and pleasures.
Such experiences are common with many persons, who yet remain in a
condition of health.
Passing now to the conditions of the mental side of the human system, we
find, in what are called healthy states, that there exists as broad a
diversity of character as in the physical. While some apprehend any thing
a little abstruse with great difficulty, or fail to do so at all, others
understand it with a readiness which we are accustomed to call intuition;
while many occurrences seem merely to impinge upon and glance off the
minds of some persons never to be remembered again, they pass from the
minds of others only after long years, or remain through life.
Some persons always look upon and judge of occurrences and results in an
unusual way. They are odd or singular in their mental constitution, and
are accustomed to do odd and out-of-the-way things just as naturally as
others would do the same things in such a manner as to attract no
attention. Some persons see, hear, taste, touch, and smell so much more
quickly and delicately than others, that we must conclude there exists a
radical difference in the perfection of the organization of the
nerve-cells of these various organs of special sense.
Again, there are periods in the experience of some persons, when they see,
hear, touch, taste, and smell with much greater readiness and delicacy
than at other times, even in a state of so-called health. Musical sounds
are more delicate and pleasing; harsh and rough sounds are more harsh and
rough; certain articles of food produce a keener sense of relish, and
colors a greater sense of pleasure: all of which would indicate temporary
changes in the structure or function of the nerve element comprising these
special organs of sense.
The same is true to even a larger extent of the emotional nature. Persons,
in certain states of the nervous system, are pleased with persons,
objects, and sensations, which afford them no pleasure at other times;
they are displeased and pained, while in other conditions, with sentiments
which would at other times produce no such effect. They sometimes feel
that the world and its possessions and pleasures are so great and grand
that they can never leave them, and the thought of doing so causes the
keenest anguish; while in another state all these pleasures and
possessions appear as empty and valueless as a bubble of air, and the
thought of leaving them, and throwing off the burdens and cares of life,
which are usually so much enjoyed, seems almost pleasurable.
Again, some persons have periods of being irritable, restless, nervous;
they cannot bear much; little incidents which, in other conditions of the
nervous system, they would think little or nothing of, turn them into a
passion of excitement, which can hardly be controlled for the time being.
In other states they may long to weep, or to be in solitude where they
cannot be disturbed; or they may shout, and laugh, and talk, while
thoughts come coursing through the brain so fast that words fail in their
expression.
The same changes occur among the impulses; these are at times almost
irresistible. Nearly every one, while standing on a high cliff or
house-top, has felt an impulse to jump off or push his friend off,
reckless of the consequences.
In the usual condition of the nervous system persons love their children
and relatives, and are ready to do and suffer and at times even to die for
them, if need be, while at other times all these sentiments fade away, so
that they are unconscious of them, and even the opposite sentiment of
dislike or hatred takes their place.
Periods of mental lethargy come over many persons at times, so that they
care neither to talk nor engage in any of their usual intellectual or
physical pursuits; and such stimuli as are usually sufficient to rouse the
brain into action appear to have very little effect. They feel and say
that there is a state of only partial brain-activity. At other times the
brain acts with the greatest freedom; occurrences which took place long
years before, and which, perhaps, have not been thought of since, come
back with all the freshness of yesterday. Thoughts come rapidly. Keen
flashes of wit, bright scintillations of thought, forms of expression of
unusual felicity, pour forth spontaneously, while the mind apprehends and
retains many kinds of knowledge with the greatest readiness. Similar
variations take place in reference to courage and its opposite, timidity;
truthfulness and suspicion; and, in fact, the whole range of mental
endowments.
Now all this grand play of diverse emotions and conditions in the
psychical functions takes place in a state of health; still, there can be
no doubt that it comes from an unstable condition of the nervous elements
of the brain, or from changes produced in some manner in these varied and
delicate structures. It may be from varying states which are constantly
occurring in the blood, in the processes of reception and elimination; or
from those delicate chemical operations which must be forever going on in
the nerve elements of the brain hemispheres, affecting their recipient and
sensitive capacities; or it may be from other unknown causes: and these
changes occur much more readily and frequently in some persons than in
others.
Bearing in mind, now, these conditions of the physical and mental systems,
the tendencies to which are inherited, and more or less changeful in
character, we may proceed a step farther.
This unstable condition, both physical and mental, may exist not only as
an inherited condition, but it may be produced, or become greatly
increased by causes external to the system, which are brought into contact
so as to influence it.
A few illustrations may serve to make this more clear:
1. When a person who has not been accustomed to use the muscles of the arm
in active and vigorous exercise, lifts, or makes a strong effort to lift,
a heavy weight, if the effort is continued any considerable length of
time, two conditions result therefrom:
First, a state of tremulousness, or spasm of the arm, hand, and especially
of the fingers. The largest effort the individual can make toward
controlling this irregularity of movement, is insufficient, and these
parts remain in a condition of more or less spasmodic action, until the
nervous energy is restored.
Second, there results a sensation of pain, more or less severe, according
to the time the exertion has continued. This would indicate positive
injury, to some extent, in the nerve filaments of the muscles which have
been so unusually exercised. The degree of effect will be dependent upon
the condition of the nerves of the hand and arm at the time the effort is
made, and upon the amount of force expended.
If the effort is repeated soon, there will result a similar condition, and
ultimately the nerve would cease to respond to the call for action in any
degree,--the arm would be paralyzed.
2. All are more or less familiar with that condition which is usually
termed the _writer's cramp_. Sometimes persons of a peculiar nervous
organization, who have been accustomed to spend many hours a day in the
mechanical process of writing, experience such a loss of nervous energy
that the arm fails to respond to the will power. There results spasmodic
and irregular movements in the arm, and more especially in the fingers,
indicating that some morbid condition of the median nerve has been
produced. If the case is neglected, and the exciting causes continue in
operation, after awhile the nerve will become less and less responsive to
the call of the will, and the arm may become seriously affected, after a
longer or shorter period of more or less pain. In this case, as in the
former one, there may exist all degrees of impairment of nerve function,
from that of slight unsteadiness or instability, up to entire failure.
3. The condition of the nervous system in chorea presents another
illustration. Between the ages of ten and fifteen years, in some children,
there may occur such changes in the condition of the nervous element,
from the altered character of the blood, as to render it more or less
unstable in some portion. One arm or one leg, or a hand, or some of the
muscles of the face or neck, cannot be kept long at rest by any effort
which can be exerted by the individual, and this may be so slight as
scarcely to attract attention, or it may be so great as to cause extreme
suffering for a long time, and ultimately destroy life.
Now the primary condition in the above cases is one of _instability of
nerve function_. Such a change has occurred in the elemental tissue of the
nerve, as to injure its power of activity so far as it is under the
control of the will. The nerve has been stimulated to over-activity, or
its energy impaired by other causes arising within the system itself.
These illustrations have related to those portions of the nervous system
which are more immediately connected with motion, and which, consequently,
are located in the muscular system. If, now, we pass from these portions
of the nervous system up to its grand centre, or that part of it whose
function is connected with mental operations, we shall find similar
effects resulting from like causes.
If a person experiences a sudden mental shock, occasioned, it may be, by
sad intelligence of some kind, or if he passes suddenly through some great
personal peril, or if he has made unusual mental effort in some abstruse
study, or in the conduct of business, which has been long protracted, he
becomes conscious of what is called mental fatigue. The brain refuses to
respond to any calls which may be made upon it for further action, or
partially refuses; it becomes confused and bewildered, and unsteady in its
action; it is difficult to force it to further application, or to
connected lines of thought, and if, by a strong effort of the will, this
is done during a short time, it is inclined soon to wander from the
subject, and there exists a more or less distinctly recognized sensation
of pain as well as inability to regulate its action.
In this case, also, as in the others, there may result any degree of
effect, from a sensation of fatigue up to mental spasm, and the amount
will depend on the condition of the brain during the time the effect
continues, and its intensity. The two conditions of instability and pain
may be less marked in the case of the brain than in the nerves of motion,
but there can be little doubt there has resulted something of a similar
character in both.
Precisely in what this change which has taken place consists, may not be
easily determined. There may have occurred actual lesion of nerve element,
or only impairment or exhaustion of functional power without lesion;
probably the latter condition only, in the primary stages of the
operation. Certain portions of the brain have been over-stimulated in
action, and consequently their power of normal activity and stability is
impaired, as was seen in the cases of nerves distributed to the muscles of
the arm and other portions of the body.
II. Again, if the arm or hand of a vigorous person, which has long been
trained to make either large efforts, or the more delicate movements, or
again, to make but little effort in any direction, be placed in splints,
or be suspended in a sling so that there is little or no activity for a
few weeks, more or less, there results a failure of nerve-function; and
there may be any degree of impairment, from that of slight degree, such as
may be evinced by spasm, to that of paralysis.
The same is true in reference to any portion of the nervous system which
can be placed in a state of inactivity.
A few sentences of recapitulation in our process of reasoning will now be
in order.
1. We have seen that imperfection and instability of nerve-function may be
inherited; that weakness, or impairment, exists with many persons from the
time of birth, which affects more or less the functions of the various
portions of the nervous system; and that this is seen not only in the
mechanical operations of the hand and arm, in the execution of all the
more delicate movements of which it may be susceptible, but also in the
mental operations. By no possible amount of training can the nerves of
the arm in certain persons be educated to do the finer portions of
mechanism, any more than can their brains be educated to continuous or
concentrated thought on the solution of problems in the higher
mathematics; that the broadest diversity as to strength and steadiness of
nerve-function exists from the period of childhood to old age: while the
nerves and brains of some bear long-continued and large effort without
disturbance or failure of function, these portions of the system in others
soon manifest the effects of such treatment, and ere long break down; and
there may exist any degree of difference, from the manifestations of
genius, to those of imbecility.
2. We have also observed that disturbance and imperfection of
nerve-function may be produced in all persons by the action of causes
operating from without upon the nervous system, and that the results may
be similar in character, whether there has been too great or too little
exercise of function.
It will further be observed, that we have in a definite and somewhat
continuous line passed from the production of disturbance and irregularity
of the function of simple motion in the hand and arm, up to the more
complicated and less understood activities of the hemispheres of the
brain. We have seen that there exists at least a similarity in the
exhibition of failure in the functions of execution in both cases, whether
acquired or inherited.
I think there can be little doubt that there exists some such condition of
that portion of the brain which is concerned in mental operations, as I
have in a somewhat crude manner attempted to illustrate, which is the
primary condition in a large number of persons who become insane.
Precisely in what it may consist during the earlier stages we may not be
able to explain. There doubtless is no change which can be termed
_organic_ in either the nerve cell or any other portion of the substance
of the brain during the primary stages of this failure in function, but
rather an exhaustion or lack in functional power, which after a longer or
shorter period _may_ lead to organic change of structure.
Now we have only to suppose a person with a nervous system so constituted
that these conditions, which I have described as temporarily occurring
with many persons from exciting causes, are permanent, though in a latent
state, and we have that peculiar organization which we term _The Insane
Diathesis_. That is, we have a nervous system so sensitively constituted,
and illy adjusted with its surroundings, that when brought in contact with
unusually exciting influences, there may occur deranged instead of natural
mental action, and it becomes more or less continuous instead of
evanescent.
The mind passes from the control of the will, and wanders hither and
thither, or persistently holds on in one channel of thought. Its action
may become spasmodic and irregular in all degrees from slight aberrations,
or excitement, up to incoherence and mental spasm; or from slight degrees
of depression, down to almost inactivity and dementia: in short, such
abnormal conditions of mental activity as constitute insanity.
The husband hates his wife, and the wife her husband; the parent his
child, and the child the parent. We have the person, whose brain is so
perverted in its action that he feels no pleasure and experiences no
satisfaction in life, but hates it, and longs to throw off its burdens and
cares, and leaves no effort untried to accomplish it; while another is so
filled with joyous emotion, his brain is so excited in functional
activity, that he can neither eat nor sleep, but ideas flow forth in one
constant stream of words--words; bright visions appear on every side, and
his life is worth a thousand worlds. Or, we may have any other of the ten
thousand perverted mental activities which attend the "mind diseased."
"And he * * * (a short tale to make)
Fell into a sadness; then into a fast;
Thence into a watch; thence into a weakness;
Thence into a lightness; and by this declination
Into a madness, whereon he now raves
And we all mourn for."
In the above view, there does not appear to be any well-defined, sharply
bounded line between what is termed normal and abnormal mental activity in
its primary stage. The one insensibly merges into the other, while both
depend upon the physiological condition of the brain for the time being.
When that portion of it which is immediately concerned in thought is in
what is termed a healthy state, that is, a condition in which its
involuntary functions are normally performed and under the control of the
will, then we have healthy mind; and, _vice versa_, when it varies from
this condition, either from the effect of influences which have been
inherited or acquired, then we have for the time, abnormal mind. Thousands
are born into the world with brains so constituted as to become easily
deranged by external influences and experiences, and thousands more attain
to such conditions of the brain, from the frictions of life, and abuse of
its enjoyments and requirements.
If these views, in relation to the principal condition of insanity, are
correct, it is evident that the question of largest interest in relation
to its _prevention_, relates, not so much to the long catalogue of
exciting or secondary causes, as to the avoidance of such courses of life,
habits, and tendencies of society, as specially assist to develop and
perpetuate this diathesis. It now becomes necessary to suggest and
discuss, more or less fully, some of the influences which are in operation
in modern modes of education and habits of life, and which have a special
tendency to create this condition of the brain. I shall first refer to
some points in connection with present methods of education as related to
the young.