Madness is attributed to moral and physical causes. Physicians do not
agree as to the prevalence of either of these sources of human misery.
Some of them, most unjustly accused of materialism, seem to lean to the
opinion that, generally speaking, physical causes can be traced in _post
mortem_ examination; while others, equally skilled in accurate anatomical
investigations, maintain that these organic derangements are very seldom
met with.
Lawrence affirms that he had "examined after death the heads of many
insane persons, and had hardly seen a single brain which did not exhibit
obvious marks of disease;" and he further states, "that he feels convinced
from his own experience, that very few heads of persons dying deranged
will be examined after death without showing diseased structure, or
evident signs of increased vascular activity." The celebrated Morgagni
gives similar results of his extensive dissections. Meckel and Jones are
of the same opinion. However, Pinel, whose anatomical pursuits on the
subject were most extensive, clearly declares that he never met with any
other appearance within the cavity of the skull than are observable in
opening the bodies of persons who have died of apoplexy, epilepsy, nervous
fevers and convulsions. Haslam, whose experience in this matter was also
very great, asserts that nothing decisive can be obtained in reference to
insanity from any variations of appearance that have hitherto been
detected in the brain. Greding observed in two hundred and sixteen
maniacal cases which he examined, the whole of whom died of disorders
unconnected with their mental ailments, that three of the heads were
exceedingly large, two exceedingly small; some of the skull bones were
extremely thick, others peculiarly thin; in some the frontal bones were
small and contracted, in others the temporal bones compressed and narrow.
In this confusion and clashing of opinions, when unfortunately each
theorist views, or fancies that he views, functional or organic
derangements sufficiently evident (in his eyes at least) to support his
doctrine, it is no easy matter to come to a fair conclusion. It can only
be observed, that, as the wonderful sympathies of the brain with other
organs especially the viscera of the abdomen, are universally
acknowledged, the morbid condition in which the brain is occasionally
found may have arisen from a primary morbid condition of some other organ.
Hence it is difficult to say whether insanity is most generally a primary
or a secondary affection. Physical causes act both upon the brain and the
abdominal system. Concussion and compression of the brain will occasion
nausea, vomiting, and hepatic affections, and the presence of worms in the
intestines will excite convulsions and epilepsy. In regard to moral
causes, they may also act directly or indirectly upon the brain, or the
parts that sympathize with it. Sudden or violent emotions are known to
produce an immediate effect upon our digestive functions, which may in
turn by their sympathetic connexion act upon the brain and the mind,
although the connexion between brain and mind is not yet proved in any
conclusive manner.
However, in a practical point of view, whatever discrepancy of opinion may
prevail on this subject, I think it will be found advisable to consider
most, if not all recent cases of insanity, as arising from physical
causes, and therefore to submit the patient to such a medical treatment in
addition to moral aid, as the prevalence of morbid symptoms of local
derangement are more or less evident. My own experience has fully
convinced me that a morbid condition of the cerebral organ, and the
viscera of the thorax and abdomen, are invariably met with, and must have
proved of sufficient importance to develop symptoms which the slightest
observations might have detected. How far the organic derangement may have
been either the cause or the result of insanity I am not prepared to say,
but they have generally borne the appearance of having originated in undue
excitement.
On this most important subject I feel much gratification in quoting the
following opinion of the experienced Pinel: "It appears in general that
the primitive seat of insanity is in the region of the stomach and
intestinal canal, and it is from this central part that mental aberration
is propagated as by irradiation." Esquirol is of opinion that insanity
arises from a lesion of the vital functions of the brain, and not
unfrequently from a disturbance in the various points of sensibility in
different parts of the system.
That mental emotions, whether producing any alteration in the physical
condition of the individual, or not, occasion various degrees of insanity,
is proved by experience. The French revolution, during its execrable
phases, offered a wide and fertile field of observation on this subject;
and the various events that marked those fearful times were certainly well
calculated to affect any brain capable of becoming deranged. The following
results of these observations are curious: "Among the lunatics confined at
Bicetre," says Pinel, "during the third year of the Republic, I observed
that the exciting causes of their maladies, in a great majority of cases,
were extremely vivid affections of the mind; such as ungovernable or
disappointed ambition, religious fanaticism, profound chagrin, and
unfortunate love. Out of one hundred and thirteen madmen with whose
history I took pains to make myself acquainted, thirty-four were reduced
to this state by domestic misfortunes, twenty-four by obstacles to
matrimonial union, thirty by political events, and twenty-five by
religious fanaticism. Those were chiefly affected who belonged to
professions in which the imagination is unceasingly or ardently engaged,
and not controlled in its excitement by the exercise of the tamer
functions of the understanding, which are more susceptible of satiety and
fatigue. Hence the Bicetre registers were chiefly filled from the
professions of priests, artists, painters, sculptors, poets, and
musicians, while they contained no instances of persons whose line of life
demands a predominant exercise of the judging faculty,--not one
naturalist, physician, chemist, or geometrician."
The following is a return of the supposed moral causes of insanity
observed in the Salpetriere. In the years 1811 and 1812
Domestic affliction 105
Disappointed love 46
Political events 14
Fanaticism 8
Fright 38
Jealousy 18
Anger 16
Misfortunes in circumstances 77
Offended vanity 1
---
Total 323
In Mr. Esquirol's private establishment during the same period:
Domestic affliction 31
Disappointed love 25
Political events 32
Fanaticism 1
Fright 8
Jealousy 14
Misfortunes 14
Offended vanity 16
Baffled ambition 12
Intense study 13
Misanthropy 2
---
Total 168
It must be observed that the latter return, in which we find twenty-eight
persons maddened by disappointed ambition and offended pride, is of a
private establishment, whose inmates of course belonged to the better
classes of the community.
By the return from Pennsylvania, out of fifty lunatics, thirty-four cases
arose from moral causes. Of physical causes hereditary madness is the most
prevalent, as appears clearly from the following table extracted from the
registers of the Salpetriere.
Hereditary insanity 105
Convulsion during gestation 11
Epilepsy 11
Female derangements 55
Diseases of child-birth 52
Critical periods 27
Old age 60
Insolation 12
Injuries of the head 14
Fever 13
Syphilis 8
Effects of mercury 14
Worms 24
Apoplexy 60
When speaking of hereditary madness, Dr. Abercrombie is of opinion that
where a tendency to insanity exists, there may be in many cases,
circumstances in mental habits or mental discipline calculated to favour
or to counteract the tendency, when the mind wanders away from the proper
duties of life or luxuriates amid scenes of imagination, thus permitting
mental emotions, of whatever kind, to be excited in a manner
disproportional to the true relation of the object which gave rise to
them; allowing the mind to ramble among imaginary events, or to be led
away by slight and casual relations, instead of steadily exercising the
judgment in the investigation of truth.
These observations are no doubt most luminous, yet as I have elsewhere
remarked, hereditary predisposition to insanity may be brought into
action, by the constant scenes that pass in the presence of those
individuals who may daily have to witness the aberrations of an unhappy
relative. The mind dwells on the sad subject, and it becomes a source of
constant apprehension, when the mere dread of an hereditary evil is
perhaps sufficient to drive to madness. So powerful is the sway even of
imaginary terror, that we need not wonder that natural fear should be
productive of results still more injurious to our intellects. There seems
to exist a certain fascination in what we should dread and avoid; instead
of resisting evil, by a strange fatality we seem to be self-impelled to
court it. We indulge in thoughts, in hopes and fears, too often
chimerical, instead of endeavouring to dismiss them from our mind, by
other pursuits and busy occupation; and we brood upon future and ideal
miseries until we actually, from supineness and timidity, sink under their
overwhelming influence.
Esquirol relates some curious coincidences of hereditary insanity. A Swiss
merchant lost both his sons in a state of mania at the age of 19. A lady
lost her senses after childbirth at the age of 25. Her daughter became
insane in her 25th year. In one family, the grandfather, the father, and
the son, destroyed themselves at the age of 50. Near Newton, seven insane
sisters had been observed in one family. An unfortunate female in the
Salpetriere, under the influence of liquor, threw herself three times in
the river and her sister in a state of intoxication drowned herself. A
gentleman whose intellects became deranged in consequence of the
misfortunes of the revolution remained for ten years secluded in his
chamber. His daughter became insane about the same period, and with equal
obstinacy could not be prevailed upon to leave her room.
There is no doubt, but that were these early predispositions attended to
and watched, an active course of education adopted, and change of locality
resorted to, much future misery might be avoided, and possibly the
invasion of the malady arrested.
If the observations of the phrenologist are entitled to consideration, the
mind may become mainly instrumental in attaining this _desideratum_, as
the detection of certain propensities may place us upon our guard in the
education of youth. This would be a point of still greater importance,
were these organs innate, dooming us to the blind law of fatality; but the
phrenologists maintain, that the development of these organic inequalities
on the surface of the cranium are produced and developed by a
corresponding enlargement of the brain, which is greater or lesser in the
ratio of the preponderance of the organ as the indulgence in the
propensities which they indicate.
Pinel relates a curious case of hereditary mania in a man who, up to the
age of fifty, fulfilled with intelligence and activity the duties of an
important office which he held. At this period he indulged in various
excesses, and sunk in the debasement of the lowest society. These excesses
he represented to his wondering friends and acquaintances as the source of
divine pleasure and celestial enjoyment. He declared that he would erect a
temple to the god of love, and officiate himself as high priest at his
altars; he compared the very lowest of women to angelic creatures; and
finally was confined, a furious and desperate maniac.
Education carried on upon mistaken principles has also been known to
prepare the way to insanity, and La Bruyere has justly observed, that
there are parents, the study of whose life appears to have been, their
giving their children just reason not to regret their loss. Pinel has
given us the interesting history of two orphan brothers, who had been
brought up in a most anomalous manner--with extreme kindness and
effeminacy by a nurse, and with much harshness and injustice by a tutor.
The result of this erroneous management was a deficient development in
their intellectual faculties, and a debilitated frame, which gradually led
to a state of imbecility. When examined by Pinel at the age of twenty and
twenty-two, their conversation was puerile in the extreme, and they both
displayed a taste for infantile sports and pastimes, befitting children of
three or four years old. They sought to express themselves with great
volubility, but their language, consisting chiefly of broken syllables,
was scarcely intelligible. Notwithstanding their apathic appearance, by a
sort of automatic habit, every evening brought on an absurd scene of
sentimentality. They would join each other in earnest conversation in a
corner of the room; and, with bitter tears and deep sighs, bewail the loss
of their parents, who had thus left them in a helpless orphan condition,
in their tender years, expressing the sincerest affection for their nurse,
but speaking of their tutor with bitter imprecations. A great partiality
shown to one sister has driven another one to a state of dementia, that
arose from her continually dwelling on the wrongs she experienced, which,
of course, were exaggerated by jealousy.
External agents producing sudden terror have been frequently known to
bring on insanity. It is related of a child of three years of age, who was
so terrified on being brought into a madhouse, that he was subject to
horrible dreams and visions until his seventeenth year, when he became a
perfect lunatic. Women frightened during pregnancy have often become
alienated; and there are two cases reported of young ladies who were found
insane the day after their nuptials.
While disappointments and misfortunes are often the origin of insanity, a
sudden melioration in circumstances, and unexpected pleasing intelligence
have been also known to derange the intellects. A man who came into the
possession of a large fortune, after having lived for many years in
penury, was so alarmed at the thought of losing this property, that the
apprehension of the evil deprived him of his senses. An instance is
recorded of a young girl, long separated from her lover by parents averse
to their union, who became insane immediately after her marriage.
Children are generally exempted from this calamitous visitation; yet Frank
relates the case of a child at St. Luke's who had been deranged since he
was two years old. Age, to a certain extent, seems to influence insanity,
and most individuals are alienated between their twentieth and fiftieth
years. Haslam states, that out of one thousand six hundred and sixty-four
patients admitted into Bedlam, nine hundred and ten came within this
period of life. In France it appears that most cases of insanity are
noticed between the ages of twenty-five and thirty-five. One-fifteenth of
these cases among men, and one-sixth among women, are observed before
their twentieth year; and in the wealthy classes of society one-fourth
occur before the same period. The following table from Bicetre regarding
age is not without interest.
Years. Aged 15 20 30 40 50 60 Total.
-------------------------------------------
1784 ... 5 33 31 24 11 6 110
1785 ... 4 29 49 25 14 3 124
1786 ... 4 31 40 32 15 5 127
1787 ... 12 39 41 26 17 7 142
1788 ... 9 43 53 21 18 7 151
1789 ... 6 38 39 33 14 2 132
1790 ... 6 28 34 19 9 7 103
1791 ... 9 26 32 16 7 3 93
1792 ... 6 26 33 18 12 3 98
1793 ... 4 36 28 22 13 10 113
----------------------------
Total 65 329 380 236 130 53 1193
Thus it would appear that the astounding events which took place in
France, but more especially in Paris, from the year 1789, the breaking out
of the revolution, to 1793, the reign of terror, had no effect upon the
intellects of the population; unless it is supposed that the entire nation
being in a state of insanity, either madmen were not noticed as any
peculiarity, or rushed into mischief and were murdered. This observation
as to the influence of public events is confirmed by the following
statement of admissions in the Salpetriere during the comparatively
tranquil years of 1811, 1812, 1813, and 1814, although many cases of
insanity were said to have arisen from the harsh laws of the conscription.
Years. Aged 20 25 30 35 40 50 60 70 80 Total.
------------------------------------------------------
1811 ... 34 37 38 27 48 38 24 12 4 262
1812 ... 52 34 33 18 38 57 26 19 3 280
1813 ... 43 29 33 41 32 57 31 13 6 285
1814 ... 42 35 38 31 26 53 34 22 10 291
----------------------------------------
Total 171 135 142 117 144 205 115 66 23 1118
Therefore one might fairly conclude that the taking of the Bastille, the
execution of Louis XVI., the bloody sway of the Jacobins, the ambitious
wars of Napoleon, and the restoration of Louis XVIII., did not in the
slightest degree affect the brains of our happy and philosophical
neighbours.
It has been generally imagined that women are more subject to mental
alienation than men; this, however, is by no means proved by observation
in other countries, as will appear by the following calculation:
Men. Women.
1756 Marseilles 50 49
1786 Paris 500 509
1786-1794 Bedlam 4992 882
1807 St. Luke's 110 153
1802 Paris 1 to 2
---- Berlin 1 to 2
---- Vienna 117 94
---- Pennsylvania 2 to 1
1807-1812 Various Madhouses in France 488 700
1802-1814 Mr. Esquirol's establishment 191 144
---- ----
Total 6452 6536
In the Lunatic Asylum of Hanwell I have now under my care 265 males, and
351 females.
It has long been a current opinion that madness is a more common disease
in our country than any where else. This may possibly arise from the
greater number of our eccentric countrymen that are widely scattered over
the globe; and whenever an individual is observed whose manners and
conduct are totally at variance with the habits of any other member of the
community, he is generally considered an Englishman. Voltaire came to the
sweeping conclusion that one half of the nation was scrofulous, and the
other moiety insane.
However, it would appear that insanity is on the increase; for in the
report of the commissioners for licensing lunatic establishments we find
the following statement: "Insanity appears to have been _considerably_ on
the increase; for if we compare the sums of two distant lustra, the one
beginning with 1775, and the other ending with 1809, the proportion of
patients returned as having been received into lunatic asylums during the
latter period, is to that of the former nearly as one hundred and
twenty-nine to one hundred." Dr. Burrows has endeavoured to impugn the
correctness of this statement by proving that suicide is more frequent in
other countries; now, unless Dr. Burrows can prove that suicide is always
an act of insanity, which will by no means be admitted, his observation
can bear no weight.
It is but too true that in melancholy madness we often observe a
prevailing propensity to self-destruction. Dr. Abercrombie's views on this
subject are so luminous that I shall transcribe them.
"When the melancholic hallucination has fully taken possession of the
mind, it becomes the sole object of attention, without the power of
varying the impression, or of directing the thoughts to any facts or
considerations calculated to remove or palliate it. The evil seems
overwhelming and irremediable, admitting neither of palliation,
consolation, nor hope. For the process of mind calculated to diminish such
an impression, or even to produce a hope of the palliation of the evil, is
precisely that exercise of mind which in this singular condition, is lost
or suspended; namely, a power of changing the subject of thought, of
transferring the attention to other facts and considerations, and of
comparing the mental impression with these, and with the actual state of
external things. Under such a conviction of overwhelming and hopeless
misery, the feeling naturally arises of life being a burden, and this is
succeeded by a determination to quit it. When such an association has once
been formed, it also fixes itself upon the mind, and fails to be corrected
by those considerations which ought to remove it. That it is in this
manner the impression arises, and not from any process analogous to the
determination of a sound mind, appears, among other circumstances, from
the singular manner in which it is often dissipated, namely by the
accidental productions of some new impression not calculated in any degree
to influence the subject of thought, but simply to give a momentary
direction of the mind to some other feeling. Thus a man mentioned by Pinel
had left his house in the night, with the determined resolution of
drowning himself, when he was attacked by robbers. He did his best to
escape from them, and having done so, returned home, the resolution of
suicide being entirely dissipated. A woman mentioned, I believe by Dr.
Burrows, had her resolution changed in the same manner, by something
falling on her head, after she had gone out for a similar purpose.
"A very irregular modification occurs in some of these cases. With the
earnest desire of death, there is combined an impression of the
criminality of suicide; but this instead of correcting the hallucination,
only leads to another and most extraordinary mode of effecting the
purpose; namely by committing murder, and so dying by the hand of justice.
Several instances are on record in which this remarkable mental process
was distinctly traced and acknowledged; and in which there was no mixture
of malice against the individuals who were murdered. On the contrary,
these were generally children; and in one of the cases, the maniac
distinctly avowed his resolution to commit murder, with the view of dying
by a sentence of law; and at the same time his determination that his
victim should be a child, as he should thus avoid the additional guilt of
sending a person out of the world in a state of unrepented sin. The mental
process in such a case presents a most interesting subject of reflection.
It appears to be purely a process of association, without the power of
reasoning. I should suppose that there had been at a former period, during
a comparatively healthy state of the mental faculties, a repeated
contemplation of suicide which had been always checked by an immediate
contemplation of its dreadful criminality.
In this manner a strong connexion had been formed, which when the idea of
suicide afterwards came into the mind, during the state of insanity, led
to the impression of its heinousness, not by a process of reasoning, but
by simple association. The subsequent steps are the distorted reasonings
of insanity, mixed with some previous impression of the safe condition of
children dying in infancy. This explanation I think is strongly
countenanced by the consideration that, had the idea of the criminality of
suicide been in any degree a process of reasoning, a corresponding
conviction of the guilt of murder must have followed it. I find, however,
one case which is at variance with this hypothesis. The reasoning of that
unfortunate individual was, that if he committed murder, and died by the
hand of justice, there would be time for his making his peace with the
almighty between the crime and his execution, which would not be the case
if he should die by suicide. This was a species of reasoning but it was
purely the reasoning of insanity."
Still these remarks do not go to prove that suicide is always the result
of insanity, since it can in most instances be attributed to a moment of
despair and impatience under a heavy visitation of calamity, or the dread
of contempt of society. The frequency of this rash act, cannot therefore
be adduced as a proof of the greater prevalence of madness in any country.
With greater reason, self-destruction is to be referred to the want of a
proper religious education and feeling, which will enable man to bear up
against the world's vicissitudes, and deem life a more or less painful
journey to a peaceful abode.
Montesquieu was one of the many writers who attributed this propensity as
being nearly exclusive to the English. "Les Anglais," he says, "se tuent
sans qu'on puisse imaginer aucune raison qui les y determine; ils se tuent
dans le sens meme du bonheur. Cette action, chez les Romains etait l'effet
de l'education, elle tenait a leur maniere de penser et a leurs coutumes;
dans les Anglais c'est l'effet d'une maladie, elle tient a l'etat physique
de la machine."
Two very curious works on suicide have been lately published in Germany by
Dr. Arntzenius and Dr. Schlegel. The former writer divides this fatal
propensity into acute and chronic; the first marked by great physical
excitement, the latter accompanied or preceded by sadness, moroseness, and
love of solitude. Curious cases are related in illustration of this
doctrine, amongst others we remark that of an English nobleman who cast
himself into the crater of Vesuvius. A German in the same year, not being
able perhaps to travel so far, threw himself into a smelting furnace.
Several cases are recorded of individuals who formed the desperate
resolution of starving themselves. It appears that in many instances the
most trifling circumstance has driven these reckless beings to the
commission of this desperate action. The case of a young Parisian author
of the name of Escoupe, who suffocated himself because one of his dramatic
productions had been severely criticised, is well known. A German student
destroyed himself because he had a club-foot, and another youth put an end
to his existence in consequence of his not having been allowed to put on
his Sunday clothes. Dr. Schlegel has given a curious table of the means of
destruction resorted to according to the several ages of individuals, and
we give the following abstract:
By pistol. By hanging.
Between 10 and 20 years of age. 61 68
" 20-30 " 283 51
" 30-40 " 182 94
" 40-50 " 150 188
" 50-60 " 161 256
" 60-70 " 126 235
" 70-80 " 35 108
" 80-90 " 2
---- ----
1000 1000
In classing 9000 cases of suicide which happened in Paris between the
years 1796 and 1830, Dr. Schlegel concludes that what he terms the
"philosophic suicide," is that which is perpetrated after deliberation,
during the night or shortly before sunrise; whilst when it is not the
result of premeditation, it occurs during the day.
The choice between shooting and hanging may be accounted for on the same
grounds. A young man, in a fit of frantic passion, from disappointed love,
or losses at play, will probably, on his return home, seize a pistol and
blow out his brains; whereas hanging needs reflection and some preparation
and precaution, which would alone suffice to bring a reflective creature
to a proper sense of his folly, unless predetermined to destroy himself by
"philosophic suicide."
It appears in these accounts that suicide in France has greatly increased
since the revolution. The average number during the last forty-two years
being 409-5/6, the number in Paris being 1639 annually. Dr. Schlegel
informs us that there exists a society in Paris called, "Society of the
Friends of Suicide." It consists of twelve members, and a lot is cast
annually to decide which of them is to destroy himself in the presence of
the others. Certain qualifications and testimonials were required before a
candidate could be admitted into this amiable club: