Essay on the Classification of the Insane

by M. Allen

Transcribed from the [1837] John Taylor edition by David Price, email ccx074@pglaf.org

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ESSAY
ON
THE CLASSIFICATION OF
THE
INSANE.

BY

M. ALLEN, M.D.

MEMBER OF THE ROYAL MEDICAL SOCIETY OF EDINBURGH, AND OF THE
MEDICO-CHIRURGICAL SOCIETY OF LONDON; CORRESPONDING MEMBER OF THE
METEOROLOGICAL SOCIETY OF LONDON, AND OF THE PHRENOLOGICAL SOCIETIES
OF LONDON AND EDINBURGH; HONORARY MEMBER OF THE LITERARY
AND PHILOSOPHICAL SOCIETIES OF LEEDS, HULL, AND WAKEFIELD, &C.

“Thou shalt not break the bruised reed.”—Is.

“The care of the human mind is the most noble branch of medicine.”—Grotius.

LONDON:
JOHN TAYLOR, UPPER GOWER-STREET.

PREFACE.

It appears necessary to explain the somewhat abrupt commencement of this Essay on Classification. It was written, and even a great part of it printed, as a continuation of my defence in the case of Allen v. Dutton; but during the progress of printing, I soon became weary of this defensive attitude; and I also soon discovered, that so far from the ex-parte and perfectly false statements which were reported of the trial having any injurious influence, they rapidly expedited my success. Thanks to the zeal and exertion of all those friends who were anxious to counteract the effect which these falsehoods were calculated to make against me; they spoke from personal experience, and with all the ardour which gratitude and justice could inspire.

The design, therefore, of publishing it as a part and continuation of my defence, was gladly abandoned. Many of the first sheets, however, containing no improper allusion to this case, remain: I mention this, because it accounts for that which might otherwise appear an abrupt commencement, especially to those who have not previously read that defence. On this account, I shall bind up that defence, (without additional expense) at the end of this Essay, for those who may wish to have this connexion before them. It is necessary, also, to inform the reader of the origin of this Essay, for another reason, in order that he may understand (and I trust, also, under such circumstances, he will excuse) why there is so much personal minuteness in describing our system of procedure and exertions, which could not, and would not, otherwise, have been obtruded on the public.

But if, after being thus justified and compelled to come forth in my defence, the matter should be found useful, either to myself or mankind, it would be foolish affectation to seem to feel shame and regret by too anxiously apologising and explaining the origin and consequent peculiar complexion of this publication, or of those which may follow in regular succession. And it is a truth, that it has increased my zeal and strengthened my resolve to prosecute that most useful of all studies, the study of mind,—its errors and diseases, with, I trust, so ardent a love of the truth, that I earnestly pray I may be enabled to trace every error to its source; for so much does the ground appear to me to be untrodden, that I pray also, that opportunity, life, health, and encouragement may be given me to complete the work I have to do, that, however slender my talents may be, I may yet feel that they have not been given me altogether in vain.

In explaining in this Essay all the plans necessary to the moral and physical purposes of an efficient system of Classification, I have had slightly to introduce many cases and subjects to illustrate my present purpose; and feeling that I had not done them or myself justice, I have said, on these occasions, I shall hereafter treat this case or subject more amply in that part of the work in which they will be more directly and specifically introduced.

Having thus incidently introduced many subjects without their being under any specific head or title, I shall, to enable the reader to form some conception of the matter, give in the contents something like a minute dissection of the whole.

From all this, and also from what I say in my former work on Insanity, as well as in Allen v. Dutton, it will be seen that I have been induced to give pledge after pledge so repeatedly, that it becomes a serious matter, “partaking of the nature of a solemn obligation;” if, therefore, I fail to exert myself to redeem these pledges, I cannot have the excuse of those who promise without even intending to perform.

In the preliminary remarks of Allen v. Dutton, I say at the conclusion, “I find I must do even more than this, (meaning the defence); for my defence would still be imperfect without a short statement of my views on the insane. For this purpose, I propose to write the following Essays:

1st.—On Classification, and Tables in Illustration. [vi]

2nd.—The different Divisions, into which I divide the Insane.

3rd.—Their General and Specific Character.

4th.—The Correspondence between Causes and Effects.

5th.—That the Study of Mind will evolve the Principle of Universal Generalization.

6th.—Their Moral and Medical Treatment.

7th.—A Selection of Cases in Illustration.

By this I shall be able to give a more full and perfect understanding of the peculiar character and proper treatment of this particular case; and by which will be seen, though imperfectly, something of those principles, and of that spirit which has pervaded the whole of our conduct to all those entrusted to our care.

“To do all this, in connexion with the above case, would not be right, were I influenced by any improper spirit; but as my conviction is confirmed by experience, that these unjust persecutions, provided we use them rightly, are for our good, I feel in no danger of indulging in any spirit, but a spirit of gratitude and forgiveness.”

From all this, (whatever variation I may make in the plan as I proceed) as well as from what I say in my first work on Insanity, where the same principle and mode of procedure is adopted, it will be seen that my task is not a slight one. In the preface to that work, I say,

“Many subjects, not usually included in works of this kind, will be introduced; but as my reasons for doing so will best explain themselves in due course, and as one subject will be introductory to another, it is unnecessary to mention them now, particularly as it might excite critical objections, which I would rather wish to disarm than pretend to brave.

“Without presuming on the experience, knowledge, or the materials I may possess, of this I am confident, that so long as I am conscious that the love of truth is my pole-star, so long will my faith continue firm in this, that with patience and perseverance, and the love of truth for our guide, scarcely any man’s powers are so limited but he may hope to acquire some clearer views, or perhaps make some discoveries in the matters he has undertaken to investigate.

“The objects of my enquiries are very numerous, and involve so many either undiscovered or unadmitted truths, which are so closely connected with subjects of inquiry the most interesting, that I have adopted this slow and humble plan of proceeding for the present, and have suspended, for a while, my first purpose of publishing a systematic treatise on insanity.”

It is intended that each publication shall contain one subject, at least, in some measure complete, so that each part may have its distinctive title, and be had separately.

The study of mental philosophy, of which insanity is a very important part, is, of all studies, provided we are on the road where truth is the guide, the most useful to our moral state. This belief was the first motive which induced me, now more than thirty years ago, to direct my medical attention to this most radically-important, though hitherto-neglected branch of the profession, as well as to whatever seemed best calculated to make me understand the sources of all erroneous and extreme views, and which a series of painful circumstances through life have excited and continually strengthened; but it is not necessary to state them: I may, however, mention that, as early as 1807, I visited lunatic asylums con amoré, and that in 1816, 1817, 1818, and 1819, I was engaged in lecturing on Mind and its Diseases. Before this time, I had no conception that I should ever be exclusively devoted to this department of the profession, which circumstances at that period forced upon me. I trust, however, that I have endeavoured to profit by the opportunities which this new situation afforded me of more fully comprehending the nature of mind, its connection with life and organization, its diseased manifestations, and of ascertaining the best modes of co-operating with nature in the removal of them; and, at any rate, it is certain that, for the purpose of lessening the miseries and increasing the comforts of those under my care, I, for the most part, have sacrificed every personal consideration.

From 1819 to 1824, I continued medical resident and superintendant of York Asylum; and on leaving it, it was voted unanimously, “That I deserved the thanks of the Governors, for my constant and successful efforts in establishing and perfecting the mild system of treatment there.” I was again engaged in lecturing, at the request of several institutions, on Mind and its Diseases; soon afterwards, in 1825, I fixed on this situation, as the best adapted of any part of the country about London which I saw, (and I spent several weeks in the examination; nor have I since that time seen any I like better) to carry into effect my views of the treatment of the insane, either as respects the recovery or the comfort of recent or confirmed cases; for here, together with domestic comfort, diversity of occupations and amusements suited to their various states, the retirement, pure air, and sweet scenery around, afford ample scope for walks, without annoyance, and apparently without restraint; which, with judicious moral and medical management, combine many acknowledged requisites to assist the disturbed and diseased mind to regain its tranquillity, and in many cases to resume its healthy tone of action.

I shall only add, that all these views have been amply justified by the beneficial results on those entrusted to my care; so much so, that these results and my success have greatly exceeded my most sanguine anticipations.

I here gladly close these personal remarks, which have been forced from me, for self is a subject which it is seldom wise and always dangerous to introduce.

It only remains to notice another peculiarity in this essay, which is, that of having introduced some animadversions on legislators whose minds are not sufficiently pure or comprehensive to enable them to avoid the common error of overlooking general principles, and not to presume to judge and draw conclusions from the hasty, partial, and erroneous views they have acquired on the subject on which they legislate. This has often led to, or been combined with, that great selfish view of making themselves and their property the chief good, not considering the real objects of legislative care, nor “that life is more than meat, and the body more than raiment.” This it is which has corrupted all our laws, especially our criminal code, which was a system of legal murder, not justice, and a perfect scandal to the nation.

The same faults are visible in all they have done for the poor insane. They have given an undue and exclusive consideration to property and to the few extreme and violent cases; treating them and all who have the care of them as criminals. To live amongst them, appears to be deemed a crime, for which neither goodness nor talent can atone. All which must, in various ways, have an injurious influence. To banish these errors is to better the treatment of the insane. This conviction is my excuse for introducing the subject, and which makes me anxious to prove, from experience, that such extreme cases hardly have any existence at all under a proper system of treatment; and, that at all events, this liberal treatment materially lessens the horror and danger usually conceived to attend these places.

Insanity is, no doubt, a terrible visitation; but why should we allow a false and unreasonable horror to increase it? and why should we thus sever our sympathy from a disease which more than any other requires it? The medicinal virtues of the fruits of charity are best proved amongst them. Grant that the disease arises from some remote or proximate ill-directed mental states. Why should we have more horror of insanity, than many other consequences of ill-regulated minds? To me, the foul ward of some large public Hospital, is incomparably more horrible and loathsome. Such direct consequences of wickedness present the object before us in an aspect that makes it difficult for us to exercise any feelings of commiseration towards them. Not so the insane. But these are views, however, into the consideration of which I shall not enter in this place; but I mention or rather hint at the diseases of other organs, for the purpose of asserting that the reality and appearance of the miserable state of the insane is not so shocking as people imagine; but that still I allow it is an awful visitation.

When the gloom and horror at present thrown around establishments for the insane shall be cleared away, Dante’s inscription over the gates of Hell, will be no longer applicable to them,

“Lasciate ogni speranza, voi, ch’entrate;” [xiii]

this, or perhaps another passage from Euripides, has been imitated by our Milton,

“Here hope never comes, which comes to all.”

They will be considered houses of cure, or hospitals for the insane.

The erroneous and false impressions concerning the character and state of the insane, will be corrected. The popular impression, that they are all violent and vociferous, destructive and dangerous, will be removed. Hitherto medical writers, by selecting the most striking cases, have contributed their share to this popular error. They have been led to do this, partly because they are cases, which more naturally arrest their own observation; but chiefly, because they are more easily described, make a more interesting picture, and are the most curable. A statement of the recovery of such patients, though it may serve to exalt the writer in public estimation, is wrong in itself, and very injurious in its influence; for it increases the unreasonable horrors and false impressions entertained about the insane, and propagates and perpetuates the evils of which the public and legislature complain. They receive impressions from extreme cases, which average about five per cent. then speak and act just as if all the insane were in a similar condition.

It would seem that these prejudices and horrors of the insane exist in a much greater degree in this part of the kingdom than they do in Yorkshire. There I was in the constant habit of taking convalescent patients with me into family parties of the first respectability; and members of these families were also in the constant habit of visiting them as friends and acquaintances, and of inviting them to tea and to spend the evening at their own homes; and this practice, in most instances, had a very pleasing and beneficial influence. This was the case with other institutions; but I have not found, neither have some others found, any such faith in, and sympathy for, the insane in this part of the kingdom, but quite otherwise; and yet I am certain, it is an example they cannot too soon imitate—its beneficial influence will bring satisfaction to themselves, will remove their prejudices, destroy their painful fears, and lessen the chances of the calamity invading themselves. There is a protection around those who are striving to alleviate the distresses of others.

This difference, which I and others have experienced, makes me more anxious “to impress these views on others, and especially on those around me, in order that I may not be obliged, from too great a deference to the fears and prejudices of those I most anxiously wish to conciliate, to abridge the exercise and lessen the happy effects of a system which theory and feeling have suggested and compelled me to pursue; and which nearly twenty years’ experience and increased knowledge have confirmed and justified.” [xv]

So important have I considered just views of the insane, that I have added an Appendix for the express purpose of exhibiting a fair average of the general appearance of the insane. With the same view, I have given a few portraits of such of these cases as are now, either themselves, or their friends, dead, or little known. I had the same principle in view in my first publication, which induced me to give cases in regular rotation, “rather,” as I there say, “than the common mode of making a selection of extreme ones, that I might not give a distorted picture of the insane, nor add to the unreasonable horrors and false impressions on their state, as this has, I am convinced, been one cause of an improper spirit and conduct towards them.”

It is scarcely necessary, after what I have already said in the Appendix, again to guard the reader against the mistake of supposing that the cases and treatment described in that Appendix form any data or criterion for judging of the kind of cases and treatment in my own private establishment. The medical swing, for instance, is stated as having been useful, in some violent cases of mania; but this was even then soon laid aside as objectionable; but it would be worse than useless now, because, under a system which does not cultivate the habitual exercise of the vindictive passions, cases in which it was of use, no longer exist. In fact, to have recourse to any means which operates so much on the fears, whatever medical virtues it may appear to possess, is adopting a principal which philosophy and Christianity equally condemn. It ought ever to be the aim of all persons IN POWER to call in no principle but that of the OMNIPOTENCE of SYMPATHY and BENEVOLENCE; and this PRINCIPLE is not to be excluded even from those whose spirits are imprisoned in bodily evils and diseases.

CONTENTS.

	Page
On the buildings, grounds, situation, and system,necessary for all purposes of an efficient classification	[1]
Illustrated by an interesting case of recovery, No.106.	[5]
Do. do. do. No. 195.	[12]
On the common division of Insanity into Mania andMelancholia, not necessarily being separate classes of cases, butgenerally, merely variable states of the same case,requiring corresponding changes and modes of moral treatment	[15]
This view of these cases is confirmed, and their dangerforewarned, by an examination of the natural constitution of mindand previous habits of those subject to these states	[18]
The delicate treatment which such cases often require,renders a separate house, where the medical proprietor andsuperintendant and family reside, of great importance, as wellfor them as for milder and convalescent cases	[25]
That cases under this system, are induced, when they knowit from experience, or have it faithfully explained to them, tocome and return without fear or reluctance	[28]
Thegreat importance of this first step; and of making truth thebasis. The manner of doing this explained, and itsbeneficial influence stated	[29]
Illustrated by an interesting case of recovery, No.335.	[36]
Ditto do. do. No. 373.	[45]
Further observations on such cases and the aboveprinciples	[47]
That suitable classification and association is betterthan entire seclusion	[49]
Illustrated by cases, No. 425 and No. 429	[51]
On the beneficial influence of their being accustomed tothe usual habits, manners, and privileges of civilized life	[53]
On the propriety of diminishing the prejudices which existagainst the mere residence at an Asylum, if for the purpose ofrestoration	[59]
The evils of considering diseases of the brain as agreater disgrace, and as an indication of greater criminalitythan other diseases	[61]
That our aim in all our moral treatment should be, to callforth self-control, and all the better principles and feelings ofthe human mind; and that this important subject will beresumed	[65]
Illustrated by a case, No. 372.	[69]
Do. do. No. 395.	[71]
That often we have only a choice of evils, and must choosethe least	[73]
Illustrated by a case, No. 421.	[75]
Do. do. No. 396.	[77]
Onthe use of exercise, and a retired situation for the purpose	[78]
An account of a system of cure, by being made to work,related by Dr. Gregory	[81]
Regular work always useful, when willingly undertaken, butnot otherwise; easily managed with the labouring, but asdifficult with a higher, class of patients	[82]
The danger of irritation, illustrated by a case	[83]
The contrary system of soothing, illustrated by a case	[84]
Further remarks and quotations on this subject	[86]
The talents and sacrifices all this requires, and theirinfluence,	[89]
Notwithstanding all this apparent extra trouble, it is,when done from right motives, the safest and easiest in theend	[100]
That these views are based on the firm ground of Christianphilosophy	[108]
CONTENTS OF APPENDIX.
Explanation of the object ofthis Appendix; which is, by giving a correct description of thestate and character of a fair average number of old insane cases,to counteract the usual misconceptions and prejudices existingagainst them	[111]
Case No. 1.—His eccentricity, and exaggeration ofhis natural character and that of his family. Has seasonsof excitement	[113]
Observation 1st.—That the fluctuations of the animalspirits of the old insane often depend on causes which equallyact on the sane; but, that from differences of state andcircumstances, the effects are very different	[115]
Case No. 2.—Though in a very torpid state, yet hehas (as every case has) his distinguishing peculiarities	[116]
Illustrated by a Portrait	[116]
Observation 2nd.—That mind is a garden which we mustcultivate—a fire which requires stirring and feeding	[116]
Case No. 3.—An example, which indeed every one is,more or less, of the correspondence, as far as the remnants ofmind exist, between his present and original character andorganization. His habits of employment, and its happyinfluence	[118]
Illustrated by a Portrait	[118]
Observation 3rd.—On the use of employment, and itseasy application	[119]
Case No. 4.—That of an idiot. Odd displays ofan increase of animation	[120]
Illustrated by a Portrait	[120]
Case No. 5.—Torpid lethargy. His naturalcharacter amiable	[121]
Case No. 6.—Though in a very singularly derangedstate, evinced by the most extravagant fancies and exploits,which he delights to detail to every one, yet he is constantlyemployed, useful, and happy	[122]
Illustrated by a Portrait	[122]
Observation 4th.—The explanation of the peculiarityof his character, proves that, in all cases, truth should neverbe violated in our conduct towards them	[124]
Case No. 7.—A very singular case of periodicalviolence and sleep. His habit of gyration described	[125]
Observation 5th.—His habit of gyrationexplained. How far the generally alternate states ofexcitement and depression of the insane is the return of theirprimary disease, or for the most part, merely the habits acquiredof irregularly expending their nervous energy, which fluctuationsare further increased by the usual atmospheric causes ofexcitement and depression	[127]
The influence of temperature, moisture, climate, seasons,diurnal periods, atmospheric changes, and different years, on ourhealth and spirits, and the type of our diseases, (and that thissubject will be resumed), and how all this is modified by thestates, habits, and circumstances of the insane	[129]
Why they are less subject to the prevailing diseases	[133]
Themental condition must, in all diseases, be considered	[134]
Illustrated by cases	[135]
How the state of mind and circumstances of the insane mustmodify these physical influences	[136]
Why this is differently exhibited by the insane, than itis by those who retain the power over their own spirits	[137]
That this view is proved to be correct, by the fact thatthese causes produce different effects by their being underdifferent modes of treatment	[139]
That the various character of insanity is but the sameexcitement of the vital energies operating on different parts ofthe mind, according to previous or present habits and states	[143]
Hence, the insane are often caracatures of their own, aswell as of family habits and character	[146]
The truth of this reasoning proved by the fact, that thegreatest number of insane cases occur when mental conflicts andworldly struggles are greatest, and among those whose minds areill regulated or miserably circumstanced; but still it does notnecessarily and always follow that those whose minds are mostwicked are soonest overthrown, but sometimes the reverse	[147]
The practical object of these observations	[150]
Case No. 8.—One of the extreme cases of furiousmania, with a leprous eruption of the skin	[151]
Observation 6th.—Whether cutaneous disorders arecommon to the insane? The treatment of this case	[153]
Case No. 9.—One proof, out of many, which proves,that the last strongest impression of their sane state continuesprominent, even when their minds seem for ever lost to themselvesand all passing objects around them	[154]
Case No. 10.—In which an injury on the head producedsymptoms in correspondence with the phrenological office of thepart injured	[155]
Case No. 11.—Apparently perfect dementia, and yet heis always employed	[156]
Observation 7th.—An excellent illustration thatthere is scarcely any insane person’s mind so much lost,but that still, provided labour has been their early commonhabit, they may with ease be brought into habits of usefulemployment, and which with such a class, should, both for theircure and comfort, be adopted, and arrangements made for thepurpose	[157]
Case No. 12.—A female instance of scolding andkindness by turns	[158]
Case No. 13.—Constantly talking to imaginaryobjects, but still perseveres in his habits of usefulness	[159]
Case No. 14.—A beautiful exhibition of femalekindness and love of children, as well as of many other symptomswhich indicate that her former habits and general naturalcharacter and disposition have been amiable	[159]
Illustrated by a Portrait	[159]
Case No. 15.—Like a passionate and proud man in aconstant state of inebriation	[161]
Observation 8th.—A striking instance of thecorrespondence between cause and effect	[162]
Case No. 16.—Vanity turned into stone	[163]
Illustrated by a Portrait	[116]
Case No. 17.—An unmarried female, useful as alaundress, and distinguished by her affection for cats andkittens	[163]
Case No. 18.—An extreme instance of the most furiousexcitement of the vindictive and destructive passions, and thehabits and states to which his treatment had reduced him	[164]
Observation 9th.—The mistake of calling those facts,which are the effects of improper treatment, symptoms ofinsanity	[166]
Case No. 19.—Constantly like one muttering in hisdreams. Very good-natured	[167]
Observation 10th.—Perhaps his reason might have beenre-awakened by constant judicious treatment and attention	[168]
Case No. 20.—An ideot, but employed	[168]
Illustrated by a Portrait	[168]
Case No. 21.—Was formerly in states of furiousrevenge, now gradually diminished in frequency and degree, bykindness	[169]
Observation 9th.—A happy illustration of the effectsof kindness	[170]
Case No. 22.—Mind a perfect wreck—the effectof disappointed love	[170]
Case No. 23.—A very interesting caricature ofpolitical mania of a person of family and title. He fancieshimself constantly employed in making calculations and in doingmany strange acts, all necessary parts of his mighty taskof paying the national debt, which abstracts him from allexternal objects, and from all consciousness to his own bodilysensations	[171]
Observation 12th.—That the correspondence betweenthe present and previous habits of mind, are, in most cases, andcertainly in this, most striking	[175]
On the effects of heat and cold, and the changes oftemperature in the insane	[175]
That we are not to mistake, which is often done, the mind,in a state of abstraction, being insensible to the externalchanges of temperature, for the physical system being unaffectedby their action	[175]
That the changes and unequal diffusion of heat correspondwith the general and particular state of the mind, and that incases of pure intellectual abstraction, and in those excited bythe bad passions, it is very different, and in cases of gradualdecay of mind, it is altogether defective	[176]
To discriminate those differences is necessary to regulateour treatment according to the exigencies of the case	[179]
Observation 13th.—On the effects of intense studyand general intemperance of the mind	[180]
That when study is blamed, I have often found that theintemperate feelings, wicked and irregular habits, were the realcauses	[180]
That proper mental exercise is as essential to the healthas bodily exercise	[181]
That it is a great error to suppose such exerciseinjurious or discountenanced by religion, provided always themind is under the influence of right motives	[182]
Case No. 25.—A dignified exhibition of all themental energies arranging and concentrating themselves under hisself esteem	[190]
Illustrated by a Portrait	[190]
Case No. 26.—A caricature of a masculine female	[193]
Case No. 27.—One of extreme torpor and debility	[193]
Observation 14th.—That the character of allhereditary cases retains something of a family resemblance	[194]
Case No. 28.—A caricature of JohannaSouthcott’s followers	[195]
Illustrated by a Portrait	[195]
Case No. 29.—A most horrible object of demoniacalviolence suspended twice by a physical accident and disease	[197]
Observation 18th. [26]—On thedoctrine of demons, and that the subject will be resumed in anafter part of this work	[198]
Case No. 30.—A very interesting demonstration of themisery of ill-assorted marriages, and that the painful andpowerful association of the original cause of the diseaseproduced its frequent recurrence	[199]
Observation 19th.—On the evils of such marriages,and that the consideration of this important subject will beresumed in an after part of this work	[202]
Case No. 31.—A singular and most interesting case ofan active, excitable, and overworked mind being overthrown byfamily afflictions, his power of personating variouscelebrated characters of different periods of the world, which hebelieves himself for the while to be. His splendideloquence and conversations with imaginary beings, &c. Still, there were encouraging symptoms, that by proper andlaborious methods of mental occupation, he might possibly havehad the balance of his mind restored	[203]
Illustrated by a Portrait	[203]
General explanation of the peculiar complexion of thiswork, and of the Appendix in particular	[207]
Concluding observations, that the object of this Essay,and especially of the Appendix, has been to lessen the prejudicesagainst and better the treatment of, the insane	[209]