Readers in general require a definition of the subject, which an author
proposes to treat of; it is the duty therefore of every writer, to define,
as clearly as he is able, that which he professes to elucidate.
A definition of a disease, should be a concentrated history, a selection
of its prominent features and discriminative symptoms.
Of the definitions which have been given of this disease, some appear too
contracted; and others not sufficiently precise.
Dr. Mead, after having treated largely upon the subject, concludes, "That
this disease consists entirely in the strength of imagination." If the
disease consisted entirely in the strength of imagination, the imagination
ought to be equally strong upon all subjects, which upon accurate
observation is not found to be the case. Had Dr. Mead stated, that,
together with this increased strength of imagination, there existed an
enfeebled state of the judgment, his definition would have been more
correct. The strength, or increase of any power of the mind, cannot
constitute a disease of it; strength of memory, has never been suspected
to produce derangement of intellect; neither is it conceived, that great
vigour of judgment can operate in any such manner; on the contrary it will
readily be granted, that imbecility of memory must create confusion, by
obstructing the action of the other powers of the mind; and that if the
judgment be impaired, a man must necessarily speak, and generally act, in
a very incorrect and ridiculous manner.
Dr. Ferriar, whom, to mention otherwise than as a man of genius, of
learning, and of taste, would be unjust; has adopted the generally
accepted division of Insanity, into Mania and Melancholy. In Mania, he
conceives "false perception, and consequently confusion of ideas, to be a
leading circumstance." The latter, he supposes to consist "in intensity of
idea, which is a contrary state to false perception." From the
observations I have been able to make respecting Mania, I have by no means
been led to conclude, that false perception, is a leading circumstance in
this disorder, and still less, that confusion of ideas must be the
necessary consequence of false perception.
By perception, I understand, with Mr. Locke, the apprehension of
sensations; and after a very diligent enquiry of patients who have
recovered from the disease, and from an attentive observation of those
labouring under it, I have not frequently found, that insane people
perceive falsely, the objects which have been presented to them. It is
true, that they all have false ideas, but this by no means infers, a
defect of the power by which sensations are apprehended in the mind.
We find madmen equally deranged upon those ideas, which they have been
long in the possession of, and on which the perception has not been
recently exercised, as respecting those, which they have lately received:
and we frequently find those who become suddenly mad, talk incoherently
upon every subject, and consequently, upon many, on which the perception
has not been exercised for a considerable time.
It is well known, that maniacs often suppose they have seen, and heard
those things, which really did not exist at the time; but even this I
should not explain by any disability, or error of the perception, since it
is by no means the province of the perception to represent unreal
existences to the mind. It must therefore be sought elsewhere, probably in
the senses, or in the imagination.
I have known eight cases of patients, who insisted that they had seen the
devil. It might be urged, that in these instances, the perception was
vitiated; but it must be observed, that there could be no perception of
that, which was not present and existing at the time. Upon desiring these
patients to describe what they had seen, they all represented him as a
big, black man, with a long tail, cloven feet, and sharp talons, such as
is seen pictured in books. A proof that the idea was revived in the mind
from some former impressions. One of these patients however carried the
matter a little further, as she solemnly declared, she heard him break the
iron chain with which God had confined him, and saw him pass fleetly by
her window, with a truss of straw upon his shoulder.
It must be acknowledged, that in the soundest state of our faculties we
sometimes perceive things which do not exist. If the middle finger be
crossed over the forefinger, and a single pea be rolled under their
extremities, we have the perception of _two_. By immersing one hand into
warm, the other into cold water, and afterwards suddenly plunging them
both into the same fluid, of a medium temperature, we shall derive the
sensations of heat, and cold from the same water, at the same time.
The power, by which the mind perceives its own creations and combinations
is perhaps the same, as that by which it perceives the impressions on the
senses from external objects. We possess the faculty of raising up of
objects in the mind which we had seen before, and of prospects, on which
we had formerly dwelt, with admiration and delight; and in the coolest
state of our understanding we can even conceive that they lie before us.
If the power which awakens these remembrances in a healthy state of
intellect, should stir up distorted combinations in disease, they must
necessarily be perceived; but their apprehension, by no means appears to
imply a vitiated state of the faculty by which they are perceived. In
fact, that which is represented to the mind, either by a defect or
deception of the senses, or by the imagination, if it be sufficiently
forcible and enduring, must necessarily be perceived.
That "confusion of ideas" should be the necessary consequence of false
perception, is very difficult to admit. Perhaps much may depend, in the
discussion of this point, on the various acceptations in which confusion
of ideas may be understood.
It has often been observed that madmen, will frequently reason correctly
from false premises, and the observation is certainly true: we have indeed
occasion to notice the same thing in those of the soundest minds. It is
very possible for the perception to be deceived in the occurrence of a
thing, which, although it did not actually happen, yet was likely to take
place; and which had frequently occurred before. The reception of this as
a truth in the mind, if the power of deducing from it the proper
inferences existed, could neither create confusion, nor irregularity of
ideas.
Melancholy, the other form in which this disease is supposed to exist, is
made by Dr. Ferriar to consist in "intensity of idea." I shall shortly
have an opportunity, in the definition I propose to give, of attempting to
prove, that this division of Insanity, is neither natural nor just, upon
the ground that the derangement is equally complete in both forms of the
disease. We ought to attend more to the state of the intellect, than to
the passions which accompany the disorder.
By intensity of idea, I presume is meant, that the mind is more strongly
fixed on, or more frequently recurs to, a certain set of ideas, than when
it is in a healthy state. But this definition applies equally to mania,
for we every day see the most furious maniacs suddenly sink into a
profound melancholy; and the most depressed, and miserable objects,
become violent and raving. We have patients in Bethlem Hospital, whose
lives are divided between furious, and melancholic paroxisms; and who,
under both states, retain the same set of ideas.
Insanity may, in my opinion, be defined to be _an incorrect association of
familiar ideas, which is independent of the prejudices of education, and
is always accompanied with implicit belief, and generally with either
violent or depressing passions_. It appears to me necessary, that the
ideas incorrectly associated, should be _familiar_, because we can hardly
be said to have our ideas deranged upon subjects, concerning which we have
little or no information. A peasant, who had heard that superior comforts
of life, with fewer exertions, were to be obtained by emigrating to
America, might saddle his beast with an intention of riding thither on
horse-back, without any other imputation than that of ignorance; but if
an old and experienced navigator, were to propose a similar mode of
conveyance, I should have little hesitation in concluding him insane.
Respecting the prejudices of education, it may be observed, that in our
childhood, and before we are able to form a true, and accurate judgment of
things, we have impressed upon our minds, a number of ideas which are
ridiculous; but which were the received opinions of the place in which we
then lived, and of the people who inculcated them; such is the belief in
the powers of witchcraft, and in ghosts, and superstitions of every
denomination, which grasp strongly upon the mind and seduce its credulity.
There are many honest men in this kingdom who would not sleep quietly, if
a vessel filled with quicksilver were to be brought into their houses;
they would perhaps feel alarmed for the chastity of their wives and
daughters; and this, because they had been taught to consider that many
strange and unaccountable properties are attached to that metal. If a
lecturer on chemistry were to exhibit the same fears, there could be no
doubt that he laboured under a disorder of intellect, because the
properties of mercury would be known to him, and his alarms would arise
from incorrectly associating ideas of danger, with a substance, which in
that state is innoxious, and whose properties come within the sphere of
his knowledge.
As the terms Mania, and Melancholy, are in general use, and serve to
distinguish the forms under which insanity is exhibited, there can be no
objection to retain them; but I would strongly oppose their being
considered as opposite diseases. In both, the association of ideas is
equally incorrect, and they appear to differ only, from the different
passions which accompany them. On dissection, the state of the brain does
not shew any appearances peculiar to melancholy; nor is the treatment
which I have observed most successful, different from that which is
employed in Mania.