When patients are admitted into Bethlem Hospital, an enquiry is always
made of the friends who accompany them, respecting the cause supposed to
have occasioned their insanity.
It will readily be conceived that there must be great uncertainty
attending the information we are able to procure upon this head: and even
from the most accurate accounts, it would be difficult to pronounce, that
the circumstances which are related to us have actually produced the
effect. The friends and relatives of patients are, upon many occasions,
very delicate upon this point, and cautious of exposing their frailties
or immoral habits: and when the disease is a family one, they are
oftentimes still more reserved in disclosing the truth.
Fully aware of the incorrect statement frequently made concerning these
causes, I have been at no inconsiderable pains to correct or confirm the
first information, by subsequent enquiries.
The causes which I have been enabled most certainly to ascertain, may be
divided into _physical_ and _moral_.
Under the first are comprehended _repeated intoxication_; _blows_ received
upon the head; fever, particularly when accompanied with delirium; mercury
largely or injudiciously administered; the suppression of periodical or
occasional discharges and secretions; hereditary disposition, and
paralytic affections.
By the second class of causes, which I have termed _moral_, are meant
those which are applied directly to the mind. Such are the long endurance
of grief, ardent and ungratified desires, religious terror, the
disappointment of pride, sudden fright, fits of anger, prosperity humbled
by misfortunes[4]: in short, the frequent and uncurbed indulgence of any
passion or emotion, and any sudden and violent affection of the mind.
There are, doubtless, many other causes of both classes which may tend to
produce the disease. Those which have been stated are such as I am most
familiar with; or, to speak more accurately, such are the circumstances
most generally found to have preceded this affection.
The greatest number of these moral causes may, perhaps, be traced to the
errors of education, which often plant in the youthful mind those seeds of
madness, which the slightest circumstances readily awaken into growth.
It should be as much the object of teachers of youth, to subjugate the
passions, as to discipline the intellect. The tender mind should be
prepared to expect the natural and certain effects of causes: its
propensity to indulge an avaricious thirst for that which is unattainable
should be quenched: nor should it be suffered to acquire a fixed and
invincible attachment to that which is fleeting and perishable.
Of the more immediate, or, as it is generally termed, the proximate cause
of this disease, I profess to know nothing. Whenever the functions of the
brain shall be fully understood, and the use of its different parts
ascertained, we may then be enabled to judge, how far disease, attacking
any of these parts, may increase, diminish, or otherwise alter its
functions. But this appears a degree of knowledge which we are not likely
soon to attain. It seems, however, not improbable that the only source
from whence the most copious and certain information can be drawn, is a
laborious attention to the particular appearances which morbid states of
this organ may present.
From the preceding dissections of insane persons, it may be inferred, that
madness has always been connected with disease of the brain, and of its
membranes. These cases have not been selected from a variety of others,
but comprize the entire number which have fallen under my observation.
Having no particular theory to build up, they have been related purely
for the advancement of science and of truth.
It may be a matter affording much diversity of opinion, whether these
morbid appearances of the brain be the cause or the effect of madness: it
may be observed, that they have been found in all states of the disease.
When the brain has been injured from external violence, its functions have
been generally impaired if inflammation of its substance, or more delicate
membranes has ensued. The same appearances have for the most part been
detected when patients have died of phrenitis, or in the delirium of
fever: in these instances the derangement of the intellectual functions
appears evidently to have been caused by the inflammation. If in mania the
same appearances be found, there will be no necessity of calling in the
aid of other causes to account for the effect; indeed it would be
difficult to discover them. Those who entertain an opposite opinion, are
obliged to suppose, _a disease of the mind_. Such a morbid affection, from
the limited nature of my powers, perhaps I have never been able to
conceive. Possessing, however, little knowledge of metaphysical
controversy, I shall only offer a few remarks upon this part of the
subject, and beg pardon for having at all touched it.
Perhaps it is not more difficult to suppose that matter peculiarly
arranged may _think_, than to conceive the union of an immaterial being
with a corporeal substance. It is questioning the infinite wisdom and
power of the Deity to say, that he does not, or cannot arrange and
organize matter so that it shall think. When we find insanity, as far as
has hitherto been observed, uniformly accompanied with disease of the
brain, is it not more just to conclude, that such organic affection has
produced this incorrect association of ideas, than that a being, which is
immaterial, incorruptible and immortal, should be subject to the gross and
subordinate changes which matter necessarily undergoes?
But let us imagine _a disease of ideas_. In what manner are we to effect a
cure? To this subtle spirit the doctor can apply no medicines. But though
so refined as to elude the force of material remedies, some may however
think that it may be reasoned with. The good effects which have resulted
from exhibiting logic as a remedy for madness, must be sufficiently known
to every one who has conversed with insane persons, and must be considered
as time very judiciously employed: speaking more gravely, it will readily
be acknowledged, by persons acquainted with this disease, that if insanity
be a disease of ideas, we possess no corporeal remedies for it: and that
to endeavour to convince madmen of their errors, by reasoning, is folly
in those who attempt it, since there is always in madness the firmest
conviction of the truth of what is false, and which the clearest and most
circumstantial evidence cannot remove.